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 S> 1 ; 
 
 
 
THE 
 
 ANATOMY 
 
 OF 
 
 THE HUMAN EAR, 
 
 ILLUSTRATED BY A 
 
 SERIES OF ENGRAVINGS, 
 
 OF TIIE NATURAL SIZE; 
 
 WITH A TREATISE ON 
 
 THE DISEASES OF THAT ORGAN, 
 
 THE CAUSES OF DEAFNESS, 
 
 AND 
 
 THEIR PROPER TREATMENT. 
 
 BY THE LATE 
 
 JOHN CUNNINGHAM SAUNDERS, 
 
 DEMONSTRATOR OF PRACTICAL ANATOMY AT ST. THOMAS** 
 HOSPITAL, FOUNDER AND SURGEON OF THE LONDON 
 INFIRMARY FOR CURING DISEASES OF THE EYE. 
 
 FIRST AMERICAN FROM THE SECOND LONDON EDITION. 
 
 WITH NOTES AND ADDITIONS BY 
 
 WM. PRICE, M. D. 
 
 ONE OF THE SURGEONS TO THE PENNSYLVANIA HOSPITAL, &C. 
 
 PHILADELPHIA: 
 
 PUBLISHED BY BENJAMIN WARNER, AND SOLD ALSO AT HIS 
 STORES IN RICHMOND, VA. AND LOUISVILLE, KEN * 
 
 AND BY 
 
 W. P. BASON, CHARLESTON, S. C. 
 
 1821. 
 
 FRANKISH, PRINTER. 
 
' 
 
 
 
 
 
 . 
 
 
 
 
 
THE ANATOMY 
 
 AND 
 
 IDSDUilSISS 
 
 OF 
 
 THE HUMAN EAR. 
 
To A ST LEY COOPEB, Esq. F. E. S, 
 
 Sir, 
 
 The dedication of this book to you 
 indulges at once my gratitude and my 
 ambition. I avail myself of this opportu- 
 nity to acknowledge the many obligations 
 which your kindness and uniform attention 
 have conferred on me. With pleasure I 
 render this tribute to your friendship. 
 
 In seeking the authority of your name, I 
 have consulted the means of enhancing my 
 own reputation. AFbo can more properly 
 patronize a work on the Ear, than one who 
 has signalized himself by the elucidation of 
 its diseases? — Who so well appreciate the 
 merits which it may possess, or shield its 
 defects against the severity of criticism? — 
 The world is acquainted with your profes- 
 sional abilities, and respects your opinion. 
 Your enthusiasm and unremitting endea- 
 vours to cultivate the department of Surgery, 
 are displayed in the works which you have 
 
Ylll 
 
 already given to the public; and it is con- 
 fidently predicted that your talent for ob- 
 servation, quickened by an ardent desire to 
 improve the science, will contribute fresh 
 accessions to our knowledge, and add 
 lustre to the profession. 
 
 But it is not merely by your own labours, 
 great as they are, that you benefit society. 
 Placed as a principal teacher in the first 
 medical school in Great Britain, you impart 
 a portion of your energy to your pupils, 
 many of whom will be excited by the 
 influence of your example to professional 
 exertions not unworthy of the place where 
 they received their education. 
 
 I am, Sir, 
 
 With respect and attachment. 
 
 Your most obedient Servant, 
 
 J. C, SAUNDERS. 
 Ely Place , March 12, 1806. 
 
 I 
 
ADVERTISEMENT 
 
 TO THE 
 
 AMERICAN EDITION. 
 
 Since the publication of Mr. Saunders’ work 
 on the Ear, medical literature has been enrich- 
 ed by a valuable treatise on the same subject 
 by Mr. Curtis, a pupil, and the most distin- 
 guished successor, of Mr. Saunders, in the 
 treatment of diseases of that organ. — Vari- 
 ous other essays, and cases of a similar cha- 
 racter having since appeared in the British 
 Journals,' it has been the object of the Edi- 
 tor to embody in the present edition of Mr. 
 Saunders, all the valuable information to be 
 derived from these sources, so as to render 
 the work as complete a Monograph on the 
 Diseases of the Ear, as the present state of 
 Surgery will admit of. 
 
 Philadelphia, JYov. 20th, 1821. 
 
iUDWEBEttS. 
 
 SPffc 
 
 The very high estimation in which this work 
 
 is held by the Medical World, and hv the 
 Anatomical Student in particular, has indu- 
 ced the present publishers to bring forward a 
 new edition in an octavo volume, that its use- 
 fulness may become more general from the 
 portableness and the convenience of its form, 
 as well as on account of the reduced price at 
 which it can be disposed. Another consi- 
 deration has had much weight in determin- 
 
 ing its size, that of making it uniform w ith 
 Mr. Saunders’s work on the Eye; both of 
 which it is presumed w ill long remain exam- 
 ples of the deep researches of a mind, whose 
 wonderful penetration left no subject unde- 
 veloped to which he applied its powers, and 
 w hich gained for its possessor a fame in the 
 annals of science, which will only cease to 
 exist w hen science itself shall fail to benefit 
 mankind. 
 
ANATOMY 
 
 OF 
 
 THE HUMAN EAR. 
 
 CHAPTER I. 
 
 A Description of the External Part of the 
 Ear , viz. the Auricle and the Meatus Ex- 
 ternus. 
 
 The Human Ear, of which I propose to 
 treat in the following anatomical descrip- 
 tion, is an organ of the most curious and 
 exquisite structure, composed of many 
 parts, all elaborately formed for the re- 
 ception, transmission, and perception of 
 sound. The complexity and minuteness 
 of many of its constituent parts render it a 
 Aery difficult subject for description. It 
 
 will, therefore, be expedient, in order to 
 
 £ 
 
2 
 
 increase the perspicuity of' the explanation, 
 to adopt a division that shall be easy, natu- 
 ral, and consistent. 
 
 The analysis of the human Ear, shews, 
 that it is composed of three parts, evidently 
 constructed for different purposes. The 
 external part is constructed relatively to 
 the medium by which the sense of sound 
 is excited, and its configuration is well 
 adapted to collect the pulses of the air, and 
 to direct them inwardly towards the seat 
 of hearing. The internal part is the seat 
 of hearing itself, and consists of a number 
 of cavities, that contain a membranous 
 texture, on which the sentient extremities 
 of the auditory nerves are expanded. The 
 middle part is a beautiful piece of machi- 
 nery, connected with the external and inter- 
 nal parts, and designed to transmit the im- 
 pulses of the air to the auditory nerves. 
 
 The terms external, middle, and inter- 
 nal, here employed to denote the three 
 divisions of the Ear, express nothing more 
 than their position. They have been 
 adopted, defective as they are, since lan- 
 
n 
 
 guage does not afford any terms more com- 
 prehensive, whether we would derive them 
 from the uses of each division, or the differ- 
 ent parts which it comprehends. But the 
 inadequacy of the terms cannot impair the 
 propriety of the division. It is in fact the 
 division of Nature, and results from the dif- 
 ferent functions, severally performed by the 
 different parts. 
 
 The external part has obtained in com- 
 mon language, the appellation of the Ear, 
 a word full as often used to express the 
 whole organ. To avoid the confusion of 
 applying the same general term to the 
 whole as to one of its parts, I shall, in this 
 treatise, call it the Auricle. 
 
 The Auricle is placed by the side of the 
 head, and joined by its root to the Os 
 Temporis; The margin of that side, which 
 is turned from the head, is considerably 
 elevated, and the general 'concavity within 
 the margin is, by the rise of the surface, 
 subdivided into certain curvilineal grooves, 
 all of which tend towards a canal, formed 
 
4 
 
 in the root of the Auricle, the Meatus Ex- 
 ternus. 
 
 The Concha, the deepest and largest 
 depression of the Auricle, is situated at the 
 entrance of the Meatus Externus. The 
 boundaries of the Concha are formed by 
 four eminencies, viz. the Tragus, Helix, 
 Antihelix, and Antitragus. The Tragus 
 and Helix bound it before, the Antihelix and 
 Antitragus behind. 
 
 The Tragus is placed immediately be- 
 hind the Condyle of the lower jaw. It rises 
 into a little knob, and lies on the fore-part 
 of the Meatus Externus. 
 
 The Helix arises from the Concha, which 
 it partially divides into a superior and infe- 
 rior depression. It advances from its origin 
 a little before the Tragus, is soon reflected 
 in the form of a curve, and in its descent 
 gradually becoming less distinct, is lost in 
 a soft pendulous substance, the Lobe. 
 
 The Antihelix lies within, and opposite 
 
5 
 
 to the Helix, and is formed with a similar 
 curve. Above, it consists of two ridges, 
 which unite, and the eminence, formed by 
 their union, is continuous below with a little 
 projection, called the Antitragus, from its 
 possessing a situation directly opposite to 
 the Tragus. 
 
 A considerable groove is formed between 
 the Helix and Antihelix, which increases in 
 depth, as it approaches the Concha, where 
 it terminates. Another groove, formed be- 
 tween the two ridges of the Antihelix, joins 
 the former just before its termination in the 
 Concha. 
 
 These are the most remarkable appear- 
 ances of this side of the Auricle. The op- 
 posite side possesses little that requires par- 
 ticular attention. It may be said to be con- 
 vex, but in the general convexity the pro- 
 jections of the Concha, Helix, and Antihelix, 
 are readily distinguis liable. 
 
 The Auricle is composed of an elastic 
 cartilage, and the common integuments. 
 Its figure is chiefly derived from the carti- 
 
6 
 
 lage, in which the eminences and depres- 
 sions, already mentioned, are fashioned, 
 except the lower part of the Helix and the 
 Lobe. These are nothing more than dn- 
 plicatures of skin, containing a portion of 
 fat. 
 
 The root of the Auricle is disposed in the 
 form of a tube, but it is to be observed, that 
 the cartilage itself does not complete the 
 circle. This is effected by the junction of 
 the Tragus to the Helix, by a ligamentous 
 fascia, and the common integuments. 
 
 This tubular part of the Auricle is united 
 to a tubular part of the Os Temporis, and 
 they form by their union the Meatus Ex- 
 ternus, a canal leading to the interior parts 
 of the Ear. The length of this canal varies 
 in different subjects from an inch and a 
 quarter to an inch and a half, and its area 
 gradually diminishes as it approaches its 
 termination. Its shape is rather eliptical 
 than cylindrical, its direction inwards, with 
 a slight declination. It is not rectilineal 
 but winding. It is first turned upwards, 
 then downwards, and is again slightly bent 
 
7 
 
 near its termination. Its lower part is 
 longer than the upper, for it terminates, as 
 it were, by an oblique section, which is 
 closed by the Membrana Tympani, in such 
 a manner, that the Membrana Tympani 
 makes an obtuse angle with the canal above, 
 an acute angle below. 
 
 The common integuments, having co- 
 vered the cartilage of the Auricle, enter the 
 Meatus Externus, and having reached the 
 bony portion of this canal, become ex- 
 tremely thin. They form a lining for the 
 Meatus, and terminate in a pouch, that is 
 placed in contact with the exterior surface 
 of the Membrana Tympani. 
 
 The skin of the Auricle, and that of the 
 Meatus Externus, are both perforated with 
 numerous small holes, the orifices of seba- 
 ceous follicles in the former, in the latter of 
 the ceruminous ducts. 
 
 The Ceruminous Glands themselves are 
 placed exteriorly to the Cutis of the Meatus 
 Externus, in the interstices of a reticular 
 membrane. They are about the size of 
 
8 
 
 Millet seed, approach to a spherical or 
 elliptical form, and are tinged of a slight 
 yellow by the Cerumen which they contain. 
 Each little gland sends a small duct, that 
 opens in the Meatus Externus, and dischar- 
 ges the Cerumen, which is there found, 
 and answers the purpose of keeping the 
 Membrana Tympani moist. 
 
 The Auricle is retained in its situation by 
 the ligamentous connexion of the cartilage 
 with the bone of the Meatus Externus, and 
 by a strong ligament, that passes from an 
 acute point of the Helix to the Zygomatic 
 process of the Os Temporis. 
 
 The description just given, is taken from 
 the Adult Ear. In the Fcetal Ear, the 
 parts of which are less completely formed, 
 the Meatus Externus is almost entirely 
 cartilaginous and membranous. Instead of 
 a process of the Os Temporis forming a 
 considerable part of the Meatus Externus, 
 nothing more is discovered in the Foetus 
 than a slender piece of hone of an elliptical 
 figure, but not making a complete ring. 
 It contains the Membrana Tympani, and 
 
9 
 
 adheres to the rest of the Os Temporis only 
 by its extremities. The space between the 
 Tragus and this ring of hone, is occupied 
 by a very dense membrane, that seems 
 placed there as a kind of bed, in which 
 hone is afterwards deposited. As ossifica- 
 tion extends, the different parts of the Os 
 Temporis are consolidated. Indeed soon 
 after birth, the Foetal ring* is united to the 
 rest of the hone, and is gradually elongated 
 during the progress of growth, until it oc- 
 cupies the place of the membranous sub- 
 stance just mentioned. 
 
 It has already been said, that the Meatus 
 Externus terminates obliquely, and that its 
 lower part is longer than the upper, xk 
 little groove, making three-fourths of an 
 Ellipse, is formed in its extremity. It con- 
 tains the Membrana Tympani. 
 
 The Membrana Tympani is the partition 
 between the external and middle part of the 
 Ear, and is so called from its closing the 
 Orifice of a cavity named the Tympanum. 
 
 c 
 
10 
 
 CHAPTER II. 
 
 A Description of the Middle Part of the Ear. 
 viz. of the Tympanum , of the Machinery 
 contained in the Tympanum , and of certain 
 Parts annexed to each. 
 
 The Tympanum is the cavity that lies im- 
 mediately at the bottom of the 3Ieatus Ex- 
 ternus. It is formed between the squamous 
 and petrous portions of the Os Tcmporis. 
 Its figure, although irregular, approximates 
 to the spherical. 
 
 The regularity of the bony superfices, in 
 which the Tympanum is placed, is inter- 
 rupted by numerous little pits, spiculse, and 
 foramina. The depth of the Tympanum 
 is not equal in all directions. Its greatest 
 depth is opposite to the aperture of the 
 Vestibule, the least to the apex of the 
 Cochlea. The former scarcely exceeds 
 
11 
 
 three lines, the latter is hardly two. The 
 length and of breadth the Tympanum are 
 nearly equal, each measuring about the 
 third of an inch. 
 
 The Mastoid cells are placed behind the 
 Tympanum. They are large and numerous, 
 freely communicate with each other, and 
 open by a large aperture in its posterior 
 and superior part. They may be consi- 
 dered as a part of the Tympanum, for the 
 communication is perfectly tree, and they 
 are both lined with a delicate and vascular 
 membrane, that secretes a fluid to moisten 
 the internal surface, at the same time that 
 it answers the purpose of a periosteum to 
 the bony superfices. 
 
 In the anterior and lower part of the 
 Tympanum is placed the aperture of the 
 Eustachian Tube. The Eustachian Tube 
 proceeds from the Tympanum, passing ob- 
 liquely forwards and inwards by the side 
 of the internal Ala of the pterygoid process 
 of the Os Sphenoides, and opens in the su- 
 perior and lateral part of the Pharynx 
 above the velqrn Palati Mollis. The Eu- 
 
12 
 
 stachian Tubes reach their termination in 
 the Pharynx, with so great a degree of con- 
 vergency, that if they were produced, they 
 would meet each other at the hack of the 
 Vomer. 
 
 The Eustachian Tube is composed of 
 bone and cartilage. The bony portion is 
 lined with the same membrane as the 
 Tympanum; the cartilaginous with a re- 
 flection of the membrane of the Pharynx, 
 which is blended so intimately with the 
 former, that no line of distinction is per- 
 ceptible. 
 
 The bony portion is an elongation of the 
 Tympanum, and ends in a scabrous ex- 
 tremity, that receives the cartilage. The 
 cartilaginous portion, as it is called, is not 
 entirely composed of cartilage. It consists 
 on the fore part of a dense membranous 
 substance, which, together with the carti- 
 lage, affords a surface for the origin of two 
 muscles, the Levator Palati Mollis and Cir- 
 cumflexus Palati. 
 
 The two portions united, constitute a 
 
18 
 
 tube about an inch and an half, or an inch 
 and three quarters in length, of an elliptical 
 figure, the major axis of which is vertical. 
 The magnitude of this tube varies much 
 in different places. Its orifice in the Tym- 
 panum is about two lines in its major axis. 
 Hence it gradually lessens, until it does 
 not exceed one. This magnitude it pre- 
 serves for a short space, but at the junction 
 of the bony portion to the cartilaginous, it 
 suddenly enlarges, and continues to in- 
 crease, until it terminates in the Pharynx; 
 where it opens by an orifice, large enough 
 to admit a goose quill. 
 
 Besides the apertures already mentioned, 
 viz. the aperture of the Mastoid cells, and 
 that of the Eustachian Tube, two others 
 present themselves in the interior super- 
 ficies of the Tympanum. These are the 
 aperture of the Vestibule, and the aperture 
 of the Cochlea; the former called the Fe- 
 nestra ovata, the latter the Fenestra ro- 
 tunda. 
 
 The Fenestra ovata is placed in the 
 upper part of the internal superficies of the 
 
14 
 
 Tympanum, in an oblique direction, but 
 parallel with the plane of the Membrana 
 Tympani. It is not perfectly elliptical. 
 Its upper part is the segment of an ellipse, 
 the lower a straight line, connecting the 
 extremities of the segment. It exactly re- 
 sembles the base of the Stapes, a bone, 
 hereafter to be described, which shuts it 
 up, and therefore in the recent state, this 
 aperture is not to he discovered unless the 
 Stapes be displaced. 
 
 The Fenestra rotunda is lower than the 
 Fenestra ovata, and nearer the Mastoid 
 process. This aperture is also shut in the 
 recent state, by a membrane of an oval 
 figure, similar to the Membrana Tympani, 
 and like that, convex internally. It is 
 placed someway within the Fenestra ro- 
 tunda, and is not discoverable without dis- 
 section, even in the Foetal Ear, in which 
 the hone is less evolved. 
 
 The Tympanum is separated from the 
 Meatus Externus by the intervention of the 
 Membrana Tympani. 
 
15 
 
 Tile Membrana Tympani is pellucid and 
 of and elliptical figure. Its major axis is 
 placed neither vertically nor horizontally, 
 but obliquely. It is fixed in the elliptical 
 groove, at the termination of the Meatus 
 Externus, except in the posterior and su- 
 perior part, where the groove is deficient, 
 There it is attached to a rough surface of 
 the bone. 
 
 From what has been already said of the 
 oblique termination of the Meatus Exter- 
 nus, it must be evident that the Membrana 
 Tympani is very much inclined, and that 
 its superior and posterior part is not so far 
 distant from the orifice of the Meatus as 
 the inferior and anterior. It is a thin pel- 
 licle of membrane, strengthened without 
 by the cuticle of the Meatus Externus, and 
 within by the lining of the Tympanum. 
 Although always in a certain state of ten- 
 sion, yet it is not a plane: on the contrary, 
 it is verv convex towards the Tympanum, 
 and the convexity is of a conical figure, the 
 apex of which is in the centre. To this the 
 Manubrium of the Malleus is attached. 
 
16 
 
 The Membrana Tympani is exceedingh 
 Vascular. Numerous little vessels descend 
 along the Manubrium of the Malleus, from 
 which diverging twigs proceed. These 
 form beautiful and intricate inosculations 
 with a plexus of vessels ranged in the mar- 
 gin of the membrane. 
 
 The Tympanum contains four little hones, 
 articulated with each other, and forming a 
 chain of communication between the Mem- 
 brana Tympani, and the Membrane of the 
 internal part of the Ear, in which the 
 sense of hearing is seated. They are the 
 Malleus, Incus. Os Orbiculare, and Stapes. 
 
 The first of these is the Malleus, v hich 
 may he divided for the purpose of descrip- 
 tion into three portions, namely, the Manu- 
 brium, the Head, and Processus Gracilis. 
 
 The Manubrium adheres to the Mem- 
 brana Tympani. It is incur vated, particu- 
 larly at its extremity, which reaches the 
 centre of the Membrana Tympani. and 
 draws it into its convex state. 
 
The Head is joined to the Manubrium 
 by a slender portion of the bone, which some 
 have called the neck. It makes a consider- 
 able angle with the Manubrium, and its di- 
 rection is obliquely upwards and backwards. 
 It is of a globular form, but on one side the 
 surface is irregular, to fit it for a firm artic- 
 ulation with the Incus. 
 
 The Processus Gracilis passes off just 
 between the Head and Manubrium, with 
 which it makes almost a right angle. It is 
 articulated in a particular groove of the Os 
 Tenlporis, and is fixed by a ligamentous 
 substance, which has been described by 
 anatomists as a muscle. It turns in this 
 groove, and is, in a word, a pivot, on 
 which the motions of the Malleus are per- 
 formed. 
 
 The second bone is the Incus. It may 
 be divided into the body and two crura. 
 
 In the body of the bone is the irregular 
 articular surface, by which it is so firmly 
 connected with the Malleus, as to be almost 
 immoveable. 
 
18 
 
 The two Crura are of unequal lengths';' 
 The shorter Crus is thicker than the other, 
 and is placed almost horizontally. It arti- 
 culates in a little depression near the aper- 
 ture of the Mastoid cells. The ligaments, 
 which retain it in this articulation, allow a 
 considerable degree of motion. 
 
 The longer Crus descends from the body 
 of the bone, is more slender than the other, 
 and bent at its extremity towards the 
 Stapes, with which it articulates by the 
 intervention of the Os Orbiculare. Its 
 direction in the Tympanum is parallel 
 with the Manubrium of the Malleus, and 
 consequently with the Membrana Ty 111- 
 pan i. 
 
 The third bone, the Os Orbiculare, is 
 very small, hardly as big as a Millet seed. 
 Although named the Os Orbiculare, its 
 figure is oval. It may be considered as 
 an inter-articular bone, between the Incus 
 and Stapes, connected with both, but more 
 firmly ivitli the former, to which it gene- 
 rally adheres, when the bones are separa- 
 ted. 
 
19 
 
 The fourth bone is the Stapes. It consists 
 of a base and two Crura, that coalesce to 
 form the head, which is of an oval figure. 
 To this the Os Orbiculare is attached. 
 
 The two Crura are bent, and that which 
 is nearest to the Mastoid process is more 
 incurvated than the other. They are 
 grooved on the inside, and a Membrane 
 occupying the area of the Stapes is fixed in 
 the grooves. 
 
 The base of the Stapes exactly fits the 
 Fenestra Ovata, which it closes. It is kept 
 in this opening by the membranous lining 
 of the Tympanum, and the membrane of 
 the Vestibule, but enjoys a certain degree 
 of motioii. The Stapes passes from the 
 extremity of the Incus to the Fenestra 
 Ovata, in an oblique direction, so that the 
 base is a little higher than its head, and the 
 sides are between the vertical and horizon- 
 tal line. 
 
 These bones are articulated with each 
 other by capsular ligaments, of a degree of 
 tenuity proportioned to their minuteness. 
 
20 
 
 They are covered with a fine vascular 
 membrane, from which numerous little 
 vessels proceed, that penetrate their sub- 
 stance. They are the nutritious vessels of 
 the bones, and the membrane may be con- 
 sidered as their Periosteum. 
 
 The mechanism of these bones is regu- 
 lated by the action of two muscles, the 
 Tensor Membranse Tvmpani and the Mus- 
 culus Stapedeus. 
 
 The Tensor Membranse Tvmpani is 
 contained in a small bony canal, parallel 
 with the Eustachian Tube, from the carti- 
 lage of which its fibres are derived. These 
 fibres are collected into a long round 
 muscle, that passes through this canal and 
 enters the Tympanum bv a slender round 
 tendon. The tendon issuing through a 
 small aperture, at an obtuse angle to the 
 line of the muscle, is gently deflected to- 
 wards the Manubrium of the Malleus, and 
 is inserted into its upper part; 
 
 The action of this muscle retracts the 
 tendon into the aperture of the bony canal. 
 
By this the Manubrium of the Malleus is 
 drawn inwards, and the Membrana Tym- 
 pani, which is attached to it, put upon the 
 stretch. 
 
 A similar effect is produced on the mem* 
 hi •ane of the Vestibule by the contraction of 
 the Musculus Stapedeus, the fleshy belly of 
 which is contained in a canal of bone con- 
 tiguous to the Stylo-mastoid canal. It sends 
 a small round tendon through an aperture 
 of the bone, which is directed obliquely up- 
 wards to the head of the Stapes, into which 
 it is inserted. 
 
 What remains to be described of the 
 middle part of the Ear is the little nerve of 
 the Tympanum, well known by the name of 
 the Chorda Tympani. As the Portio Dura 
 of the Auditory nerve passes through the 
 Stylomastoid canal between the Tympanum 
 and Mastoid process, it detaches a small 
 branch through a particular canal, which 
 opens in the back of the Tympanum, near 
 the groove, that contains the Membrana 
 Tympani. 
 
22 
 
 The Chorda Tympani traverses the 
 Tympanum, lying between the Manubrium 
 of the Malleus and longer Crus of the Incus, 
 and enters another little canal nearly op- 
 posite to the former. It then continues its 
 course forwards and downwards between 
 the Pterygoid Muscles, and joins the Lin- 
 gual branch of the Inferior Maxillary nerve. 
 This extremity of the Chorda Tympani is 
 larger than that which is joined to the 
 Portio Dura, Avhence some have considered 
 it as a branch of the Lingual nerve. It is, 
 in a word, a nerve of communication, equally 
 belongs to both, and is connected with the 
 trunk of each at an acute angle. 
 
23 
 
 CHAPTER III. 
 
 A description of the Internal Fart of the Ear } 
 which contains the expansion of the Audi- 
 tory Nerve, and may therefore he considered 
 the Seat of Hearing. 
 
 The Internal part of the Ear, which I am 
 now about to describe, has, on account of 
 the intricacy of the canals and cavities 
 which compose it been generally denomi- 
 nated the Labyrinth. It comprehends the 
 Vestibule, semicircular canals, and the 
 Cochlea, which are incased in the Petrous 
 portion of the Os Temporis. 
 
 The Vestibule is the central cavity, and 
 communicates both with the semicircular 
 canals and the Cochlea; the latter lying 
 in the extreme point of the Petrous portion 
 of the Os Temporis, the former towards 
 the Mastoid cells. The shape of the Ves- 
 tibule is irregularly spherical. However, 
 
24 
 
 on examination, when it is properly laid 
 open, two distinct depressions are observa- 
 ble, one semi-elliptical, and situated above, 
 the other hemispherical, and situated below. 
 Both are opposite to the Meatus Internus, 
 a canal soon to be described, and the bony 
 partition is thin and perforated with nume- 
 rous small holes to transmit fibres of tlic 
 Auditory Nerve. 
 
 In the prepared bone, the Vestibule is 
 open towards the Tympanum, but as we 
 have already seen, the Fenestra Ovata is, in 
 the recent state, closed by the base of the 
 Stapes. Six other apertures present them- 
 selves in the Vestibule, five of which belong 
 to the semi-circular canals, and the sixth 
 is the beginning of one of the Scalse of the' 
 Cochlea. 
 
 The semicircular canals, although uni- 
 versally so called, are all larger then semi- 
 circles. They make at least three-fourths 
 of a circle. Their calibre is small, about 
 the size of a common pin, and of an ellip- 
 tical figure. The smallest part of each 
 canal is about the middle of its curve. They 
 
25 
 
 enlarge as they enter the Vestibule, hut one 
 extremity of each canal is particularly dila- 
 ted, and is called Ampulla. 
 
 The semicircular canals are three, and 
 are distinguished from each other by names 
 given them from their position or direction. 
 I shall call them the Vertical, the Oblique, 
 and the Horizontal. 
 
 The Vertical canal describes its curve in 
 the summit of the Petrous portion of the 
 Os Temporis, and crosses it with its convex 
 side above. 
 
 The Oblique, an the contrary, describes 
 its curve in the occipital side of the Os 
 Temporis, and its convexity is placed below. 
 
 The Horizontal canal is bent with its 
 convexity towards the Mastoid process, 
 and is directly above a portion of the Stylo- 
 mastoid canal. 
 
 The three semicircular canals enter the 
 Vestibule only by five apertures, for the 
 
 F, 
 
26 
 
 smaller extremity of the Vertical canal joins 
 the smaller extremity of the Oblique, and 
 their orifice is common’. 
 
 The Cochlea has received its name from 
 its resemblance to the shell of a common 
 snail. The resemblance is merely external, 
 and is only discernible in the Cochlea of 
 the Foetus during the first months; for as 
 ossification advances, the bony substance 
 of the Cochlea is blended with the rest of 
 the Petrous portion of the Os Temporis. 
 However, the proper substance of the 
 Cochlea may be discovered even in the 
 adult, by its greater brittleness and yellow 
 colour. 
 
 The Cochlea is constructed with a Mo- 
 diolus or central pillar, on which a Spiral 
 Tube is w ound, and a spiral Lamina w ound 
 on the same Modiolus, lying within the 
 Spiral Tube and dividing it into two. Its 
 figure is conical, and position oblique. It is 
 placed in the anterior part of the Petrous 
 portion of the Os Temporis, contiguous to 
 the canal that lodges the iuternal Carotid 
 
27 
 
 .Artery, with its base towards the Meatus 
 Interims and the apex, which is lower than 
 the base, towards the Tympanum. 
 
 To facilitate the description of the Coclr 
 lea, it will be advisable separately to consi- 
 der the three parts which form it, that is to 
 say, the Modiolis, the Spiral Tube, and Spi- 
 ral Lamina. 
 
 The Modiolus commences from the bot- 
 tom of the Meatus Internus by a concave 
 plate, perforated with numerous Forami- 
 nula, the extremities of small bony tubes 
 that freely communicate with one another, 
 and run from the base towards the apex. 
 
 The Modiolus itself consists of these little 
 bony tubes, blended into a mass of a coni- 
 cal figure. The interior fasciculi of tubes 
 are the shortest, and they lengthen towards 
 the centre, in which the longest and largest, 
 which reaches the apex of the Cochlea, is 
 placed. They terminate on the sides of 
 the Modiolus at different distances. At 
 their terminations they bend at right angles 
 towards the Spiral Tube, and their orifices 
 
28 
 
 describe about the Modiolus, a spiral tract, 
 corresponding with the tube in direction. 
 In proportion as they terminate the Mo- 
 diolus diminishes, and its apex is exceeding- 
 ly slender. 
 
 The Spiral Tube is wound on the Mo- 
 diolus, and adheres to its sides. As it runs 
 towards the apex, the curve which it makes 
 is constantly diminishing. It makes two 
 turns and a half from the base to the apex, 
 and gradually decreases in its capacity. 
 
 The Spiral Lamina arises from the Ves- 
 tibule, and u inds round the Modiolus tvith- 
 in the Spiral Tube. Its greatest breadth is 
 at its origin, whence it gradually becomes 
 narrower, as it approaches the apex of the 
 Cochlea. Two thin plates of bone com- 
 pose it, and appear to unite at their margin, 
 from which a membranous substance, which 
 is reflected on each side, proceeds. 
 
 The Spiral Lamina w ith the aid of this 
 Membrane, makes a complete septum, and 
 divides ti e Spiral Tube into two canals, 
 one of which is called the Scala Tympani. 
 
29 
 
 from its Laving an aspect towards the Tym- 
 panum, the other the Scala Vestibuli, from 
 its arising in the Vestibule. 
 
 The Scala Tympani is nearest the base 
 of the Cochlea, and begins from the Fenes- 
 tra Rotunda, but is prevented from com- 
 municating with the Tympanum by the 
 Membrane which closes this aperture. 
 
 The Scala Vestibuli begins by an oval 
 orifice between the Fenestra Ovata and the 
 Ampulla of the Vertical canal. 
 
 The two Scalse run parallel with each 
 other, but have no communication except 
 at the apex of the Cochlea. 
 
 When the Cochlea is cut obliquely from 
 the base to the apex at a proper distance from 
 the Modiolus, the section exhibits the ap- 
 pearance of three successive compartments, 
 each containing a portion of the septum of 
 the Scalse. The half turn of the septum 
 occupies the last compartment, and as it 
 joins the extremity of the Spiral Tube, a 
 
30 
 
 little hole is left. This is the hole by which 
 the Sealse communicate. 
 
 To obtain a view of this aperture of com- 
 munication, it is necessary to preserve the 
 membranous part of the septum, for the 
 Spiral Lamina itself does not reach the 
 extremity of the Spiral Tube. This may 
 be ascertained by examination of the ma- 
 cerated Cochlea, in which, when a similar 
 section is made, the extreme point of the 
 Spiral Lamina may be perceived just rising 
 into the last compartment and perfectly 
 detached; but in the recent state, the 
 Membrane, which goes off from the Spiral 
 Lamina to complete the septum, passes 
 also from its point to the extremity of the 
 Spiral tube, where it is so attached, as to 
 leave the little hole already mentioned. 
 
 In the occipital side of the Os Temporis, 
 contiguous to the Vestibule and Cochlea, 
 is the canal through which the Auditory 
 Nerve passes. It is named Meatus Inter- 
 nus, is oval, and about the third of an inch 
 in length. The extremity towards the 
 
31 
 
 labyrinth is closed except at the upper 
 part, where a small foramen, which is the 
 beginning of the Stylo-mastoid canal, ap- 
 pears. 
 
 Immediately below this foramen, two 
 cribriform plates are placed, the upper op- 
 posite to a portion of the semi-elliptical 
 cavity of the Vestibule, the lower to the 
 hemispherical. 
 
 A little lower, and separated by a slight 
 ridge, a cribriform sulcus is continued to a 
 round concave cribriform plate, the base of 
 the Modiolus of the Cochlea. 
 
 The Vestibule, semicircular Canals, and 
 the Cochlea, are lined with a delicate Pe- 
 riosteum. They contain also a membra- 
 nous texture, formed into sacs and tubes, 
 and filled with a transparent fluid, similar 
 to the aqueous humour of the Eye. 
 
 The membranous sacs and tubes are 
 smaller than the osseous cavities which 
 contain them, but exactly correspond in 
 shape. They adhere very slightly to the 
 
S2 
 
 Periosteum of the osseous cavities by an 
 exceedingly fine cellular membrane. 
 
 The Vestibule contains two membranous 
 sacs, one seated in the hemispherical de- 
 pression, the other in the semi-elliptical. 
 I shall call them by the names of the de- 
 pressions, in which they are lodged. 
 
 The semi-elliptical sac is larger than the 
 hemispherical, and is that in which the 
 membranous semicircular canals and Scala 
 Vestibuli centre. Although the cavities of 
 these sacs are distinct, the sacs themselves 
 cannot be separated, because theire sides 
 are in contact with each other, adhere, and 
 are too delicate to admit of division by dis- 
 section. 
 
 The membranous semicircular canals 
 exactly resemble the osseous tubes in 
 which they are placed, and, therefore, re- 
 quire no farther description. They open 
 in the semi-elliptical sac. 
 
 The Membranous Tubes of the Cochlea 
 correspond with the Scalse. One arises 
 
33 
 
 from the semi-elliptical sac of the Vestibule, 
 the other from the membrane of the Fenes- 
 tra Rotunda, to which it adheres. They 
 communicate, as the two Scalse do, in the 
 apex of the Cochlea. 
 
 The fluid contained in the cavities of 
 these membranes is secreted by their inte- 
 rior surface, in the same manner as the 
 Liquor Pericardii is secreted by the Peri- 
 cardium. A considerable degree of vascu- 
 larity seems the necessary consequence of 
 their secretory functions. The vessels which 
 supply them, pass from the Periosteum in 
 a serpentine direction, and so far are easily 
 discovered; but when dispersed on the pe- 
 culiar structure of the Membranes, tliev 
 are too minute to admit the red globules of 
 the blood. 
 
 The Membranous Texture, just described, 
 is destined to receive the ultimate distribu- 
 tion of the Auditory nerve or Portio Mollis 
 of the seventh pair. It arises from the Tu~ 
 berculum Annulare in the Ventricle of the 
 Cerebellum, and the Crus Cerebelli. As it 
 turns round the Medulla Oblongata, it is 
 
 F 
 
joined by the Portio Dura, which it partially 
 receives in a species of groove, and both 
 enter the Meatus Internus, being connected 
 by a fine cellular membrane. 
 
 The Portio Dura quits the Portio 3Iollis 
 at the bottom of the Meatus Internus, and 
 continues its course through the Stylo- 
 mastoid canal, and is no otherwise con- 
 nected with the Organ of Hearing, than as 
 it receives the Chorda Tympani. 
 
 The Portio Mollis consists of two Fasci- 
 culi nearly of equal size, one of which sup- 
 plies the Vestibule and semicircular canals, 
 the other the Cochlea. 
 
 The nerve of the Vestibule and semicir- 
 cular canals subdivides into three branches 
 after forming a gangliform swelling. The 
 largest branch sends its fibrils through the 
 cribriform plate opposite to the semi-ellip- 
 tical sac of the Vestibule. They pass in a 
 distinct plexus upon the Sac, and are lost 
 in a pulpy substance, which vanishes in the 
 Ampulla of the Vertical and Horizontal 
 membranous canals. 
 
35 
 
 The second branch passing through the 
 inferior cribriform plate is dispersed in a 
 similar substance on the Hemispherical sac. 
 
 The last branch also passes through a 
 small cribriform plate, and is lost on the Am- 
 pulla of the Oblique membranous canal. 
 
 The Fasciculus of the Cochlea is twisted, 
 an appearance which arises from the mode 
 in which its fibres enter the Modiolus. As 
 they pass through its substance, they form 
 plexuses through the communicating holes 
 of the bony tubes. Some of the fibres issue 
 from the Modiolus through the'Foraminula 
 of the Spiral Lamina, but the greater num- 
 ber and the largest issue through the Fora- 
 miimla, between the Spiral Lamina, and 
 the junction of the Spiral tube to the Mo- 
 diolus. 
 
 As the nerve detaches its fibres along the 
 spiral tract of the Foraminula, it lessens 
 towards the apex, as the Modiolus itself 
 does, but its central filament passes straight 
 through the central foramen of the Modi- 
 
36 
 
 olus, and ramifies on the half turn of the 
 Spiral Lamina. 
 
 The fibrillse of the nerve may be dis- 
 tinctly seen as they enter the Scalae of the 
 Cochlea, making a distinct plexus on the 
 Spiral Lamina in the edge of which a per- 
 fect network is formed. This network ap- 
 pears to be continued in a semi-pellucid 
 pulpy substance, which goes from the edge 
 of the spiral Lamina on the membranes of 
 the Scalffi, and is said to resemble the Re- 
 tina; but a structure, so minute and intri- 
 cate as this, must for ever elude perfect 
 investigation. 
 
37 
 
 The causes of Loss or Imperfection of 
 Hearing are very numerous, as may easily 
 be conceived by those who have contem- 
 plated the complexity of the Ear. They 
 are involved in the greatest obscurity, and 
 I am fully sensible that all which I shall 
 offer on this subject is to be considered 
 only in the light of an Essay. 
 
 Few attempts have hitherto been made 
 by Anatomists to investigate the morbid 
 changes to which the Ear is liable. On 
 this head we are almost destitute of infor- 
 mation, at a period when by their labours 
 the diseases of the other Organs of the 
 body have been ascertained, and the symp- 
 toms which accompany them recorded. 
 .But our Ignorance will soon cease to be 
 
38 
 
 the cause of astonishment, if we reflect on 
 the obstacles which oppose our inquiries. 
 These are almost insuperable. Nature has 
 placed the greater part of the Ear in a situ- 
 ation absolutely beyond the reach of ex- 
 amination in the living body, and as its 
 diseases are rarely, if ever, mortal, morbid 
 Ears are seldom dissected in the dead. 
 Such observations as are related have most- 
 ly been made on subjects that have casu- 
 ally fallen into the hands of the Dissector, 
 and the history of the cases is unknown. 
 
 But it would not suffice if Anatomy were 
 able to develope every morbid alteration 
 of structure of which this Organ is suscept- 
 ible. A great object would indeed be 
 gained, but a greater would still remain 
 unaccomplished. Before the mind of the 
 practitioner can be directed to any de- 
 terminate object; a history of symptoms 
 must be annexed to each specific change, 
 and these symptoms must be sufficiently 
 distinct. This demands a multitude of 
 dissections and a series of attentive obser- 
 vations. A clear and distinct recital of 
 symptoms is rarely obtained from the deaf. 
 
39 
 
 They are conscious of their infirmity, but 
 very few are impressed with a notion that 
 Hearing may he impaired by a variety of 
 causes. The approach of Deafness is insi- 
 dious and often unattended with pain. Few 
 strong impressions are made on the mind 
 of the patient, and he loses his faculty of 
 hearing so imperceptibly, that in general his 
 friends sooner discover his misfortune than 
 himself. 
 
 Here then the labour and the difficulty 
 commence; but the field is open. Anato- 
 mists have, to the present da} r , avoided this 
 subject, some doubtless convinced of the 
 impracticability, and others disgusted at 
 the difficulty of the enquiry. As Anatomists 
 have neglected the investigation of these 
 diseases, so practitioners have either aban- 
 doned such patients to Quacks, or consign- 
 ed them to the care of Providence. 
 
 But although I admit the difficulty in all 
 instances, and in many our total inability to 
 obtain an adequate knowledge, yet X must 
 differ from those who think that such cases 
 should be abandoned. I am convinced that 
 
40 
 
 the subject may be very much elucidated, 
 if many individuals, having great opportu- 
 nities of examining dead bodies, and ani- 
 mated with proper zeal in the inquiry, 
 would employ some portion of their time 
 in the dissection of such diseased Ears as 
 chance may subject to their inspection. 
 By this proceeding many facts respecting 
 defects or diseased changes of structure in 
 the Ear may soon be obtained. In many 
 instances, where a previous acquaintance 
 with the patient affords the opportunity, 
 the attendant symptoms may he ascertain- 
 ed. Thus the observer, combining in one 
 view the cause and effect, may be capable 
 in many instances of inventing means of 
 relief. 
 
 But it must be admitted that such perfect 
 researches into the cause and seat of the 
 diseases of the Ear, however they may en- 
 large our knowledge, will not in an equal 
 degree augment our ability to remedy 
 them. The maladies of the interior parts 
 of the Ear constitute a very numerous class, 
 amounting; at least to one third of the 
 causes of deafness. As these are seated in 
 
41 
 
 the Labyrinth, a part of the Ear inacces- 
 sible in the living subject, operative Sur- 
 gery is excluded from all chance of reliev- 
 ing them. 
 
 The impossibility of curing the defects 
 of the Internal part of the Ear by manual 
 operations is therefore manifest, but it by 
 no means follows that such cases are irre- 
 mediable. Many morbid changes of the 
 vital organs of the body, equally inscrut- 
 able as the Ear, in the living subject, are, 
 when we know the symptoms indicating 
 their existance, successfully treated by the 
 operation of internal remedies: and I have 
 no doubt that deafness in various instances 
 depends on morbific changes which are 
 curable by the general treatment of the 
 constitution. I trust I shall he able to 
 prove, in the course of the following pages, 
 that the assemblage of symptoms which 
 practitioners, for want of a more appropri- 
 ate term, have conspired to call Nervous 
 Deafness, not only admits of relief, but may 
 be completely cured in the incipient state. 
 
 i 
 
 These preliminary observations have been 
 6 
 
42 
 
 made purposely to display to tlie reader 
 the difficulty of treating successfully many 
 of the diseases of the Ear, and not with a 
 view to discourage him from the attempt. 
 I know the character of the profession too 
 well to suppose that its members can be 
 deterred by difficulties, or that there are 
 not many who would think no time mis- 
 spent, that is employed in endeavours to 
 heal the infirmities of the species. 
 
 I have necessarily exhibited the dark 
 side of the picture, as my intention in 
 making these reflections has been directed 
 to the most abstruse and inscrutable dis- 
 eases of the organ. The prospect will 
 brighten as wo enter more into the detail. 
 We shall then find that some are very sim- 
 ple, and attended with too little difficulty 
 in practice, to be introduced in the general 
 outline. 
 
 Of those too which occupy the more com- 
 plicated parts, all are not equally unknown 
 and remediless. Mr. Cooper has proposed 
 and executed the happy and successful ex- 
 pedient of perforating the Membrana Tym- 
 
43 
 
 pani, in that species of deafness which an 
 obstructed Eustachian Tube produces. 
 
 It has been my humble endeavour to in- 
 vestigate another disease of the Tympa- 
 num, the puriform discharge, to ascertain 
 its origin and progressive stages, and to 
 point out a proper mode of treatment. 
 
 OF THE DISEASES OF THE MEA- 
 TUS EXTEENUS. 
 
 Tut diseases which attack the Meatus 
 Externus are the most simple to which the 
 Ear is liable. They admit of examination 
 by inspection and the touch, and are there- 
 fore generally well understood. 
 
 The Meatus Externus is subject to in- 
 flammation. An inflammation of this part 
 in consequence of the hard and unyielding 
 materials which compose it, is accompanied 
 with the most acute pain, and a great de- 
 gree of general excitement. Its cure should 
 
44 
 
 be attempted by resolution. It is enough 
 to say that the most active antiphlogistic- 
 plan is necessary to accomplish this inten- 
 tion. 
 
 When the means employed to reduce 
 the inflammation have not succeeded, and 
 matter has formed, it is generally evacuat- 
 ed, as far as I have observed, between the 
 Auricle and Mastoid process, or into the 
 Meatus. If it has been evacuated into the 
 Meatus, the opening is most commonly 
 small, and the spongy granulations, squeez- 
 ed through a small aperture, assume the 
 appearance of a Polypus. Sometimes the 
 small aperture by which the matter is eva- 
 cuated, is in this manner even closed 
 and the patient suffers the inconvenience 
 of frequent returns of pain from the reten- 
 tion of the discharge. When the parts 
 have fallen into this state, it will be expe- 
 dient to hasten the cure by making an in- 
 cision into the sinus between the Auricle 
 and Mastoid process. 
 
 It occasionally happens that the bone 
 itself dies, in consequence of the sinus 
 
45 
 
 being neglected, or the orginal extent of 
 tbe suppuration. The exfoliating parts are 
 tbe Meatus Externals of tlie Os Temporis? 
 or tbe external lamina of tbe Mastoid pro- 
 cess. 
 
 A short time ago I was consulted by a 
 patient, according to whose account, and 
 as far as I could judge from the examina- 
 tion of parts that were healed, the whole 
 Meatus Externus must have exfoliated; 
 and I saw a child a few weeks ago, in 
 w hom the outer part of the Mastoid process 
 was in a state of exfoliation. 
 
 The Meatus Externus and Auricle are 
 sometimes affected with an herpetic ulcer- 
 ous eruption. It always produces a great 
 thickening of the integuments, and the 
 passage is often so much closed that a great 
 degree of deafness ensues. The ichor 
 which exudes from the pores of the ulcer- 
 ated surface, inspissates in the Meatus, and 
 not only obstructs the entrance of sound, 
 but is accompanied with a great degree of 
 fetor. This disease is not unfrequent. I 
 have never seen it resist the effect of alter- 
 
46 
 
 alive medicines, and tlie use of the appli- 
 cations employed in the following cases. 
 
 CASE I. 
 
 Miss S. E. applied for a complaint in her 
 Ear, that had for many months greatly 
 diminished the power of hearing. It proved 
 on examination to he an Herpetic ulcera- 
 tion of the Meatus Externus and Auricle. 
 The orifice of the Meatus was almost closed. 
 With difficulty I introduced the nozzle of 
 a syringe, and brought out a considerable 
 quantity of inspissated discharge. The 
 oozing of the ichor was very great. 
 
 She was perfectly cured at the end of 
 two months by taking two grains of Calo- 
 mel every day; and the injection of a lo- 
 tion of Hydrargyrus Muriatus cum Aqua 
 Calcis, and the application of the Unguen- 
 tum Hydrargyri Nitrati. 
 
 CASE II. 
 
 Mr. R. W. applied with similar symp- 
 toms, only in an inferior degree. He had 
 
47 
 
 laboured under the complaint above a 
 twelvemonth. His defect of hearing dur- 
 ing this time had varied greatly, accord- 
 ing, as I suppose, to the degree of thick- 
 ening in the parts, or the inspissation of the 
 discharge. 
 
 He was cured by a similar treatment in 
 the course of three weeks. 
 
 Miss C. IV. A similar case. The disease 
 had existed in different degrees of force for 
 several months. 
 
 She was cured at the end of a month by 
 the exhibition of Calomel, and the injection 
 of a solution of Argentum Nitratum. 
 
 The lining of the Meatus Externus, like 
 that of the nostrils, is capable of producing 
 excrescences. They are generally termed 
 Polypi. Such as have fallen under my in- 
 spection more nearly resemble syphilitic 
 warts, and appear to be produced in a si- 
 milar manner, viz. by irritation. I have 
 never observed these excrescences in the 
 Meatus Externus, when the Tympanum is 
 
48 
 
 sound. But a purulent discharge from the 
 Tympanum is complicated with the form- 
 ation of Funguses and Polypi, as will he 
 seen in the proper place. However, I do 
 not mean to deny the existence of these 
 excrescences when the other parts of the 
 organ are sound. I am certain they are 
 very rare, but when they do arise, are 
 easily treated. They should be extracted 
 with Forceps, and the part from which 
 they are torn, touched with caustic, intro- 
 duced with proper caution, that it may 
 not extend to the Membrana Tympani. 
 
 The passage of the Meatus Externus has 
 occasionally been obstructed by an unna- 
 tural septum, originating from an elonga- 
 tion or diseased growth of the Cutis. As 
 we have been informed, this was the state 
 of the Meatus in a case where the Mem- 
 brana Tympani was perfect, and Hearing 
 was restored by a laceration of the parti- 
 tion. Tide Mons. Maunoir’s communica- 
 tion in the Medical Journal for 1S00. 
 
 I believe these cases are rare, unless the 
 Tympanum be diseased, but are not unfre- 
 
49 
 
 quent after a suppuration and puriform 
 discharge. The following is an instance 
 of its having formed after a puriform dis- 
 charge. 
 
 I. Hallam applied at the Dispensary for 
 a very considerable and sudden increase of 
 a deafness, with which he had been many 
 years afflicted. The deafness had originally 
 been produced by a suppuration of the 
 Tympanum, and he recollected, that during 
 the discharge, air had occasionally passed 
 through the Meatus in the act of blowing 
 his nose. The discharge had ceased to flow 
 outwardly, and he was no longer capable 
 of forcing air through the Meatus. He 
 now spoke of a particular sensation, similar 
 to what people experience when they inflate 
 the Tympanum. By placing the patient 
 in the light of the sun, I perceived a septum, 
 which I pierced and lacerated, after which 
 the patient could perceive at nine inches, 
 the tick of a watch, which he was before 
 obliged to place in contact with his Ear. 
 Some difficulty arose to prevent the reunion 
 of parts. It was at last accomplished, and 
 
 the patient’s hearing improved to the 
 
 n 
 
50 
 
 degree in which it is usually possessed by 
 those who have lost the Membrana Tym- 
 pani. 
 
 But the most common impediment to 
 hearing, that depends on the state of the 
 Meatus Externus, arises from the inspissa- 
 tion of the Cerumen. The quantity which 
 may be collected without impairing the 
 power of hearing, cannot easily be deter- 
 mined. In many persons the quantity is 
 naturally considerable. But unless its 
 proper consistence be altered, the functions 
 of the passage are not much injured, 
 whereas a small portion of hard Cerumen, 
 lodged on the Membrana Tympani, will 
 deprive a person of his hearing. 
 
 The symptoms, which are attached to 
 the inspissalion of the Cerumen, are pretty 
 well known. The patient, besides his 
 inability to hear, complains of noises, 
 particularly a clash or confused sound in 
 mastication, and of heavy sounds like the 
 ponderous strokes of a hammer. 
 
 The practitioner is led by the relation of 
 
51 
 
 such symptoms to suspect the existence of 
 wax; but he may reduce it to a certainty 
 by examination. 
 
 Any means capable of removing the 
 inspissated wax, may be adopted, but 
 syringing the Meatus with warm water is 
 the most speedy and effectual, and the only 
 means necessary. As the organ is sound, 
 the patient is instantaneously restored by 
 its removal. A little pleasant distress arises 
 from the violent excitement produced in the 
 Ear, as soon as it is acted upon in this state 
 of accumulated sensibility, by its accustom- 
 ed stimulus; “ but this soon ceases, without 
 leaving any unpleasant effect. This disease, 
 however simple, has been often mistaken or 
 overlooked and the cause supposed to lie 
 deep in the structure of the organ, whilst in 
 fact, it arose merely from the source above 
 pointed out; which show s the necessity, in all 
 cases of deafness, of ascertaining, by an ac- 
 curate examination, w hether such a mecha- 
 nical cause does exist.” 
 
 “ From its situation the external passage is 
 subject to occasional accidents, or other me- 
 
52 
 
 chanical causes than inspissated Cerumen 
 acting upon it.” 
 
 “ Thus, in cases of children, small bodies 
 as peas, cherry-stones, pins, §c. have got in- 
 to the Ear, where, exciting inflammation, they 
 often occasion considerable pain before they 
 are removed. A number of remarkable ca- 
 ses of such accidents will be found related 
 by authors, and one in particular, related by 
 Wildanus, where a bead or ball of glass 
 lodged in the passage and produced deli- 
 rium.” 
 
 “ The great art in extracting them, is to be 
 cautious not to push them deeper; they are 
 best taken out with a pair of small forceps: 
 and a little oil may he dropped into the ear be- 
 fore making the attempt.” 
 
 “ In the same way, insects at times get into 
 the Ear, which produce the most unpleasant 
 feeling in the part, as well as great noise, 
 and often actual pain; the best way of re- 
 moving them is to drown them, by filling the 
 passage with mild fluids, as water or oil, by 
 means of a syringe, and thus washing them 
 
53 
 
 out. Acrid liquors are improper; for, in the 
 endeavour to avoid tliem, the insect gets 
 deeper. The motion is often so severely 
 felt by children, as to produce a state little 
 short of delirium; after the removal, a little 
 oil of sweet almonds is the best application, 
 to soothe the irritated part. Even a little 
 oil, in the first instance, will destroy the 
 insect.” 
 
 OF THE DISEASES OF THE 
 TYMPANUM. 
 
 The first disease of the middle part of the 
 Ear, which I shall endeavour to investigate, 
 is the puriform discharge from the Tympa- 
 num. The discharge is ichorous, some- 
 times tinged with blood, and imparts a 
 yellow colour to a silver instrument. This 
 disease is attended with a loss of hearing 
 proportionate to the injury which the 
 machinery of the Tympanum has sustained, 
 and the sense is variously impaired from 
 the slightest degree up to total deafness. 
 
54 
 
 In general, when the patient blows 
 strongly with the nose and mouth closed, 
 air will be expelled at the Meatus Externus. 
 Whenever this circumstance is observed, it 
 is clear that the discharge proceeds from, or 
 is connected with an injury or destruction 
 of the Membrana Tympani. But the re- 
 verse by no means proves that the Mem- 
 brana Tympani is sound, and the discharge 
 therefore confined to the Meatus. It often 
 occurs that the same inflammation, which 
 terminates in a suppuration of the Tympa- 
 num, previously obliterates the Eustachian 
 Tube, which remains permanently closed 
 after the cessation of the inflammation 
 which occasioned it. 1 have ascertained 
 this fact by dissection, and I possess a pre- 
 paration taken from a subject in whom a 
 puriform discharge from the Tympanum 
 had ceased. In this person half the mem- 
 brana Tympani had been destroyed, but the 
 remnant had healed, and the Eustachian 
 Tube was impervious. 
 
 Although, air cannot he made to issue at 
 the Meatus Externus, we are not therefore 
 
55 
 
 authorized to - draw the conclusion, that the 
 Membrana Tympani is sound. It probably 
 is so, but it must be ascertained by actual 
 examination. The Ear must be inspected 
 in a strong light. For this purpose the 
 patient should be set in such a position that 
 the rays of the Sun may fall into the Meatus, 
 and illuminate it sufficiently to make the 
 bottom risible; or the Ear may be sounded 
 with a blunt probe, and any person ac- 
 quainted with the particular feel of the 
 Membrana Tympani, may easily distinguish 
 it by the touch. If the membrane be 
 defective, the instrument will pass iuto the 
 Tympanum, the bony superficies of which 
 is still more readily distinguishable. 
 
 He therefore, who will institute a proper 
 examination, cannot fail of arriving at a 
 certain knowledge of this disease, and will 
 not confound it with the Herpetic ulcerous 
 state of the Meatus Externus. In the latter, 
 success is certain, and as soon as the ulcera- 
 tion is cured, hearing is perfectly restored: 
 in the former, however perfectly the dis- 
 charge may be suppressed, the event is very 
 dubious. It is therefore a point on which 
 
56 
 
 a practitioner, who wishes to determine a 
 priore what benefit can be rendered in anv 
 given case, cannot be indifferent. 
 
 This state of the Tympanum is produced 
 by various causes. In the Scarlatina Ma- 
 ligna, inflammation of the Tympanum 
 attacks the patient, and advances to Gan- 
 grene. If he survives the fever, the machi- 
 nery of the Tympanum often sloughs so 
 extensively, that the membrana Tympani 
 and whole chain of bones is evacuated, and 
 the patient is perfectly deaf. 
 
 Most commonly this disease succeeds the 
 Ear-ache, which is in fact an acute inflam- 
 mation of the Tympanum. If the inflam- 
 mation should not subside spontaneously, or 
 be assuaged by art, the Tympanum and 
 Mastoid cells form a large quantity of pus. 
 After the patient has suffered the most 
 intense pain, the Membrana Tympani ul- 
 cerates, and the pus is discharged at once 
 in a large quantity. He is then greatly re- 
 lieved, but the disease ceases not, the parts 
 supply fresh matter, whicli continually 
 oozes at the Meatus. 
 
57 
 
 The symptoms produced by inflammation 
 of the Tympanum, are most intense pain 
 in the Ear and Head, a great degree of 
 symptomatic fever, and sometimes slight 
 delirium. The pain fluctuates, and its 
 paroxisms resemble the Tooth-ache. This 
 resemblance has unfortunately caused it to 
 be wholly neglected, or very improperly 
 treated. The case obviously requires the 
 most active antiphlogistic treatment, and 
 the absence of every thing stimulative. 
 But the opposite system prevails. The 
 most acrid applications and spirituous li- 
 quors are the general means employed for 
 the relief of the patient, an error that un- 
 questionably tends to produce the worst 
 catastrophe which can happen, viz. the 
 suppuration of the parts. 
 
 What part the practitioner ought to take 
 on the attack of this inflammation, is quite 
 manifest. If he should be consulted suffi- 
 ciently early, it will most probably be in his 
 power to stop the inflammation. Then all 
 the symptoms subside. The deafness, which 
 is very great during the paroxism, will 
 
 i 
 
58 
 
 gradually lessen, as the deposited lymph, 
 its necessary effect, is absorbed. 
 
 Not always, however, will the patient 
 recover his perfect hearing, even when the 
 inflammation has terminated in resolution. 
 But as I am now speaking from observation 
 on cases abandoned to the natural process, 
 I am incapable of deciding how far proper 
 treatment immediately subsequent to the 
 paroxism can obviate the defect which the 
 inflammatory state has left. Few will 
 doubt the efficacy of such remedies as pro- 
 mote absorption. If in parts which are 
 visible, we have ascertained that large quan- 
 tities of lymph are absorbed before the 
 completion of its organization, what reason 
 have we to doubt that the same tiling is 
 accomplished in parts similarly affected 
 which are not visible? We cannot resist the 
 conclusion, that the Deafness which remains 
 after an inflammation of the Tympanum is 
 not an inevitable consequence, but arises 
 from neglect, and allowing the deposited 
 lymph to become organized; and if the 
 lining of the Tympanum remain perma- 
 nently thickened, or organized adhesions be 
 
59 
 
 formed, about the chain of bones, a certain 
 defect must be the result. 
 
 But let it be admitted, that the Tympa- 
 num lias suppurated. Ought the Membrana 
 Tympani to be abandoned to a casual 
 ulceration, or is it better to open it by art? 
 I am inclined to prefer the latter; and if I 
 could be assured by any symptom that 
 suppuration has taken place, I should not 
 hesitate to make a small perforation of the 
 Membrana Tympani, and to repeat it, if 
 necessary, taking at the same time every 
 precaution to suppress the fresh collection 
 of matter. 
 
 If this mode of treatment were followed, 
 it would be practicable to evacuate the 
 matter, and cure the complaint with trifling 
 injury to the Membrana Tympani, which 
 is generally sacrificed in a spontaneous 
 discharge. 
 
 Most frequently the establishment of this 
 disease is slower and more insidious. Slight 
 paroxisms of pain attack the patient, and 
 
60 
 
 are relieved by slight discharges. These 
 recur at intervals, until at last the puriform 
 discharge is fully confirmed. 
 
 Some practitioners are disposed to regard 
 this as a trivial disease, others as one too 
 dangerous to allow the interference of art. 
 Both are in an error. It is without doubt a 
 disease, destructive in its tendeney to the 
 faculty of hearing. It rarely stops until it 
 has so much disorganized the Tympanum 
 and its contents as to occasion total deaf- 
 ness. On this account, it demands the 
 most judicious attempts to arrestits progress, 
 and these attempts are free from danger. 
 How the contrary opinion should have 
 prevailed, is unaccountable; yet many mo- 
 dern practioners condemn all attempts to 
 cure it. But what argument can be ad- 
 duced against the cure of this disease, 
 that is not equally conclusive against all 
 others. Is any one an abettor of the obso- 
 lete Humoral Pathology? He will contend 
 that the stoppage of a drain which nature 
 has established is pernicious, and the morbid 
 matter will be determined on the internal 
 parts; but how can such a person venture 
 
61 
 
 on tlie treatment of any disease, even the 
 healing of a common ulcer. Some years 
 ago I thought this absurd doctrine had been 
 totally exploded, and yet I constantly hear 
 it adduced to deter patients from interfering 
 with this disease. Is a child the subject of 
 it? The parent is told, it is best to leave it 
 to nature, and the child will outgrow it. 
 Is it an adult? Some other subterfuge 
 equally futile is employed. The truth is, 
 the disease is always tedious and difficult, 
 and not always curable, and many are dis- 
 inclined to embarrass themselves with the 
 case, who have not candour to make the 
 true statement. Thus patients are induced 
 to refrain from all attempts, until the disease, 
 in its first stages often curable, becomes 
 absolutely impracticable. 
 
 The celebrated Heberden, in his com- 
 mentaries on the causes of diseases and 
 their cure, says “ Frequens puerorum vi- 
 “ tium est, interdum quoque adultorum, 
 “ in quo Humor mali odoris post aures 
 “ exit, unde tmnent auriculae et loca vicina 
 “ et cuticula in furfures decedit. Quod si 
 “ humor acrior fuerit cutis altius exulcera- 
 
62 
 
 “ tur. Anris autem intus malo simili inter- 
 i{ dum ajjicitur , ex quo seger jit sur duster. 
 “ Medicamenta exsiccantia nocent verte. do 
 “ humorein in partes interioves. Nulla alia 
 “ curatione opus est, nisi ut loca aiiecta 
 “ ssepe abluentur aqua tepida, et ut pannus 
 et unguento aliquo leni delibutus inter- 
 “ ponatur, ne partes vel sibi invicem ag- 
 “ glutinentur, vel hsereant vestibus.” It is 
 evident, that the writer applies this obser- 
 vation principally to that cutaueous affec- 
 tion of the auricle to which new-born in- 
 fants and very young children are subject, 
 a trivial complaint, almost unworthy of a 
 place in so grave a book. But when he 
 says, u Auris autem iutus malo simili in- 
 “ terdum afficitur, ex quo seger fit sur- 
 “ daster,” it is equally clear, that he al- 
 ludes to discharges from the Meatus Ex- 
 ternus. Now I contend, that discharges, 
 capable of making the patient deaf, must 
 originate from the Herpetic ulceration of the 
 Meatus Externus, or a suppuration of the 
 Tympanum. In the former, healing me- 
 dicines. “ medicamenta exsiccantia,” are the 
 only medicines which ought to be employed, 
 and I have ample proof that these applica- 
 
63 
 
 tions will cure the disease, and not trans- 
 late it to the internal parts. In the latter, 
 the parts affected are too essential to per- 
 fect hearing to be neglected, and I shall 
 prove by the event of cases, that these may 
 be healed without detriment to the consti- 
 tution. 
 
 But the impropriety of attempting the 
 cure of this disease is not only inculcated 
 in books; many eminient practitioners are 
 tinctured with the same notion. A short 
 time ago I was consulted for a case of puri- 
 form discharge in a young lady, who, 
 having heard frequent observations from a 
 practitioner of the old school on the trans- 
 lation of morbid humours, was dubious as 
 to the safety of suppressing it. The case 
 was referred to one of the first surgeons 
 and anatomists in this metropolis, who de- 
 cided against all attempts. And truly for 
 what reason? For fear of injuring the 
 Brain! The brain can only be injured by 
 the exposure and ulceration of the Dura 
 Mater, and the application of substances 
 capable of destroying the bone and Dura 
 Mater can only be an act of madness or 
 
64 
 
 the grossest ignorance. But injury of the 
 brain is more likely to result from the con- 
 tinuance of this disease, than the judicious 
 interference of art. For the puriform dis- 
 charge naturally advances to ulceration, 
 and ulceration to denudation and caries of 
 the bone and separation of the chain of 
 bones. A caries of the Tympanum is there- 
 fore ultimately produced. But this will 
 destroy the hone, and expose the Dura 
 Mater; and if it were not for that princi- 
 ple, by which membranes that line cavities 
 thicken as the neighbouring parts arc ul- 
 cerating, and thus preserve their integrity, 
 the brain would perhaps always suffer in 
 the ultimate stage of the puriform discharge 
 from the Tympanum.* 
 
 * The following cases from Dr. Duncan Junior’s “ Contri- 
 butions to Morbid Anatomy,” contained in the 68th No. of 
 the Edinburgh Medical and Surgical Journal, illustrate very 
 happily the above opinions; the brain having became affected 
 in both instances by the continuance of the disease, with- 
 out the use of remedial measures. 
 
 « D. S. setat. 19, was admitted on the 31st August, 1820, 
 into Queensberry-House, complaining of intense headache, 
 tenderness of abdomen, and great prostration of strength, 
 pulse 60. These were treated with blisters and purgatives, 
 
65 
 
 But the fact is, the puriform discharge 
 from the Tympanum often exists without 
 
 but suffered no abatement, and terminated fatally on the 
 morning of the 5th of September. — On dissection, a consi- 
 derable portion of the small intestines were found to be in- 
 flamed, which accounted for the pain referred to that region. 
 In other respects the abdominal and thoracic cavities and 
 cerebrum were sound. Nearly all the right lobe of the cere- 
 bellum was occupied by an abscess containing about tpj, of 
 thick pus. No traces were found either of the membranes 
 or bones of the Tympanum; its cavity was filled with pus, 
 and a bunch of little red bags containiug fluid, and adhering 
 by a stalk to the side. — There was a cylindrical absorption 
 of bone in the petrous portion of the Temporal bone, which 
 was softer than usual, extending from the transverse sinus 
 across to near the Cochlea. — His sister informed, that two 
 years ago his right ear was pulled. Ever since he has had 
 severe headache and deafness of that side, occasionally there 
 was a thick yellow discharge from that ear, andjthen he en- 
 joyed better health; latterly his judgment became impaired. 
 
 J. A. jetat. 21, admitted into Queensberry Fever Hospi- 
 tal, 14th November, 1820. When between six and seven 
 years of age, his right ear began to discharge thick yellow pus, 
 in consequehce, it was thought of cold, and has continued to 
 run ever since, with occasional intermissions of weeks or 
 months. His health has been generally good and not af- 
 fected by the state of the discharge, which sometimes chang- 
 ed from thick and yellow to a thin and watery fluid; occa- 
 : onally a little blood was observed to flow. Five weeks ago he 
 
 mvplained of violent shooting pains in the affected ear; this 
 ved to the use of poultices and tepid injections. 1 he pain 
 
 K 
 
66 
 
 a caries of the bone, and antecedently to 
 this is most commonly curable. I have so 
 
 soon remitted, but the jaw of that side quickly became 
 affected, as his friends thought with rheumatism. When 
 the pain of his ear remitted some blood flowed, and the , 
 purulent discharge became much increased in quantity. His 
 complaints for nearly three weeks continued to be the fixed 
 pain of the jaw, together with great constipation of his bow- 
 els, having had but one stool in twelve days, notwithstand- 
 ing purgatives. — About ten days ago, after being exposed to 
 cold, he suddenly complained of intense headache; his head 
 was bent forwards upon his knees; he lost his voice; in about 
 seven hours the pain went off, and his voice returned. After 
 this he complained of oppression only, but, as his father 
 expressed it, was not himself again. Two days after this 
 last attack, he was brought into the Hospital. His com- 
 plaints were obstinate constipation, slight headache, pain of 
 back and body, stiffness and slight curvature of neck back- 
 wards, also delirium of a mild kind. Purgatives, venesec- 
 tion, and antlspasmodics were freely used; frictions and sti- 
 mulants were appled to the spine, but all in vain. Bowels 
 were freely opened,' but his other complaints increased. His 
 neck was obstinately drawn back; his delirium became vio- 
 lent, sighing almost incessantly, and upon the fifth day from 
 admission he died. 
 
 Dissection — In the thorax and abdominal cavities were 
 found lb. iv. of bloody extravasated fluid, with effusion of se- 
 rum below the peritoneal coat of the bladder. The first turn 
 of the duodenum contained about Ibss. of dark coloured fluid. 
 At this part, both externally and internally the coats of the 
 intestines were thick and black. The pericardium contain- 
 ed about ^ij. of serum. The posterior mediastinum was 
 
67 
 
 frequently observed this disease, that I have 
 no hesitation in saying, that there are three 
 stages of it: 
 
 much infarcted with black blood. — The spinal marrow from 
 the medulla oblongata to the second or third dorsal verte- 
 bra was softer than usual. The meningeal linings from 
 this place downwards were much distended, and on slitting 
 them freely open gij. of pus gushed out. This had dissect- 
 ed and separated to some distance the fibres of the cauda 
 equina. The base of the brain presented an astonishing ap- 
 pearance of disease. All the nerves at their origin were en- 
 circled with pus; a part of the right anterior lobe was disco- 
 loured, opposite to the dura mater, which was absorbed: a 
 large abscess was found in this lobe, containing thin pus, and 
 portions of cortical substance; the lateral, third, and fourth 
 ventricles all contained pus. The petrous portion of the 
 temporal bone was filled with pus. 
 
 Mr. Swan, of Lincoln, in the same number of the Edinburgh 
 Journal, after relating a very interesting case of purulent 
 discharge from the Tympanum of the Ear, in which astrin- 
 gent injections appeared to be the principle exciting cause of 
 a very alarming vertiginous affection, but which terminated 
 favourably; makes the following important remarks. “ When- 
 ever a purulent discharge from the ear is attended with much 
 complaint of the head, suspicions ought always to be enter- 
 tained that the dura mater is irritated in consequence; and 
 on any increase of the headache, effectual measures should be 
 taken to arrest the progress of the mischief by bleeding, and 
 a strict atiphlogistic regimen. In such cases we ought not 
 to wait until there are decided symptoms of inflammation of 
 the brain or its membranes, because then, as cases on regard 
 
68 
 
 First, a simple puriform discharge. 
 
 Secondly, a puriform discharge, com- 
 plicated with Funguses and Polypi. 
 
 show, suppuration, extending some way on the base of the 
 organ can hardly ever be prevented; but the remedies I have 
 mentioned ought to be used immediately on the increase of 
 
 pain in the head and ear. 
 
 / 
 
 To those who have not much considered the case, these 
 symptoms may not seem to require such active treatment; 
 but if both the patient and practitioner’s fears are suffered to 
 be lulled into security for many hours after their approach 
 by palliatives, the disease will have made such progress as 
 probably to resist the employment of every thing that can 
 be done. I consider, therefore, that when there is a discharge 
 from the ear, and the head is complained of, all that ought to 
 be clone is an attention to the general health, and an at- 
 tempt by counter-irritation, as blisters behind the ears or 
 on the back of the neck, to remove the disease from the ear. 
 The Meatus ought not to be stopped up with cotton or any 
 other substance to prevent the free escape of the matter, as 
 I am convinced, that when the discharge is great, such a 
 practice is very wrong, and probably not only adds to ti e ir- 
 ritation by its confinement, but may lead nature to attempt 
 some other outlet, and thus cause an absorption of the bone^ 
 and consequent exposure of the dura mater. And, upon the 
 whole, I think that on no account, in the case where the dis- 
 charge is accompanied by pain in the head, ought astringent 
 injections to be used to put a stop to the discharge, as, when 
 it has been stopped, by a perseverance in this mode of treat- 
 ment, the brain has always appeared to suffer, and the con- 
 sequences have been fatal.” 
 
69 
 
 Thirdly, a puriform discharge with a 
 caries of the Tympanum. 
 
 The time necessary to accomplish the 
 transition from one stage to another is un- 
 certain. Years do not effect it in some in- 
 stances, and in others it seems to advance 
 almost at once to a carious state of the bone. 
 
 The puriform discharge from the Tympa- 
 num is a focal disease, and does not de- 
 pend on any vice of the constitution. Ge- 
 neral remedies are therefore very ineffica- 
 cious. But as a bad state of health is 
 unfavourable to the healing of any parts, 
 so in this particular complaint, any dis- 
 ordered state of the system should be cor- 
 rected. The chief dependence is to be 
 placed on direct applications to the parts 
 affected. 
 
 Blisters and setons have been recom- 
 mended by some, with a view to effect a 
 derivation of the humour. If they are 
 beneficial, this explanation of their mode 
 of action is not grounded on just reasoning. 
 Some time ago I was averse to their use. 
 
70 
 
 But I now think they may he advantage- 
 ously employed in aid of topical applica- 
 tions. They never can be injurious, ljut 
 if indiscriminately adopted, the patient will 
 often suffer the pain and inconvenience 
 which they occasion, without reaping any 
 benefit. 
 
 As it has been stated that the degree of 
 deafness produced by this complaint is 
 various; so when it is cured, the sense is 
 restored in different degrees. For the deaf- 
 ness during its continuance is sometimes 
 very considerable when the real injury 
 which the organ has sustained is trivial. 
 In the first stage the mere thickening of 
 parts, or the collection of the discharge, 
 must impede the action of the intervening 
 machinery between the external and in- 
 ternal parts of the Ear; and in the second, 
 the mechanical obstruction of the Funguses 
 or Polypi excludes the pulses of the air. 
 On this account there is often a notable in- 
 crease of the power of hearing, when the 
 discharge is suppressed in the first and se- 
 cond stage. But as the parts are invisible, 
 it is difficult, if not impracticable, to decide 
 
71 
 
 a pviove how far the power of hearing can 
 be restored. Now this is no valid objec- 
 tion to undertaking the cure. The sense 
 will not be rendered worse by a failure, 
 and if the discharge should be stopped, the 
 disease, which caused it, is removed, the 
 organ safe from farther injury, and the 
 patient freed from an offensive malady. 
 This argument is conclusive in favour of 
 treating all stages of the disease, hut in 
 the last, the sense is almost, if not totally, 
 destroyed; and although the discharge be 
 stopped, the patient’s hearing will be very 
 little, if at all improved. 
 
 In bavins: stated above that the sense of 
 hearing is often greatly improved by a 
 cessation of the discharge, it must be un- 
 derstood that I confine the observation 
 to cases of the first and second stage, in 
 which a great part of the machinery of the 
 Tympanum still remains. In the third 
 stage, the chain of bones is nearly destroy- 
 ed, and the pus seems in a certain degree to 
 transmit sounds. I have two or three pa- 
 tients at present, who are in the habit of 
 syringing their Ears. They can distinctly 
 
72 
 
 perceive light sounds whilst the injected 
 fluid remains, but, on its escape, again be- 
 come deaf. 
 
 These are examples of caries, and al- 
 though desirable in many respects to stop 
 the discharge, I am inclined to think that 
 in this stage hearing would not he im- 
 proved. It would more probably he di- 
 minished; as the fluid discharge is I think, 
 a medium by which the pulses of the air 
 affect the seat of the nerve. 
 
 It must he admitted, that the event of 
 these cases is not always gratifying to the 
 practitioner. Often, when he has done his 
 utmost, no great degree of hearing is ac- 
 quired; nor can the discharge always be 
 suppressed. But this is chiefly attributable 
 to the error committed in allowing the dis- 
 ease to become confirmed. From the suc- 
 cess which has attended the cure of many 
 very old cases, I have every reason to sup- 
 pose that those which are recent would be 
 still more successful. From the popular 
 prejudice, encouraged by the reluctance of 
 medical men, few patients apply in the 
 
73 
 
 earlier periods of the disease. They wait 
 until their patience is exhausted, in expec- 
 tation of a natural cure, and when they do 
 apply, the opportunity is passed. 
 
 Nor, according to my observations, are 
 the means which I have seen employed 
 such as are likely to succeed; because the 
 treatment corresponds with some precon- 
 ception of its nature without any regard to 
 the different stages of the disease. One 
 thinks it a caries of the Tympanum. He has 
 recourse to Tinct. Myrrh se, and the whole 
 tribe of antiseptics. A second imagines it 
 consists in an ulceration of parts, and treats 
 it with as little delicacy as a common 
 ulcer. A third, hearing that Vinum Opii 
 and Calomel are beneficial in certain dis- 
 eases of the Eye, employs them here on a 
 forlorn hope. 
 
 If a person acts from the impression that 
 this disease exists only under one form, he 
 will, consistently with this opinion, employ 
 one general remedy; but although that 
 remedy should not be improper, he cannot 
 often succeed. The different stages of the 
 
 L 
 
74 
 
 disease require very different practice. He 
 only can be successful who will give the 
 greatest attention to individual eases, and 
 vary his means agreeably to the state of 
 each.* 
 
 When the disease is cured, the healing 
 process is effected by the extension of the 
 
 “ * The first stage of the disease” says Mr. Curtis “ will 
 often yield to an injection of.the sulphate of zinc, used night 
 and morning, which will frequently effect a cure in the space 
 of three weeks or a month. It is apt, however, to leave a 
 a morbid sensibility of the ear, which occasions pain on the 
 entrance of loud sounds. The plnmbi superacetas, or sugar 
 of lead, is equally useful as an injection. 
 
 In some cases the continuance of these injections has been 
 necessary for a considerable length of time; which it maybe 
 proper to state in order, first, that the patient may not look 
 for a speedy cure; and, secondly, that he may be induced to 
 persevere a reasonable length of time. 
 
 In the second stage of the disease, the point is to extract 
 the fungus or polypus, with a pair of small forceps; and, if 
 these excrescences do not come entirely away, to endeavour 
 to pinch the roots till the whole is removed. They may 
 then be touched with the argentum nitratum as before men- 
 tioned. 
 
 On the removal of the fungus, or polypus, the injection of 
 zinc is to be used; and in a great number of cases the hearing 
 will be restored, and the discharge suppressed.’’ 
 
75 
 
 Cutis of the Meatus into the Tympanum, 
 and its becoming continuous with its Mem- 
 branous lining. 1 have a preparation, a 
 dissection of the Ear, in which half the 
 Membrana Tympani had been destroyed 
 as far as the Manubrium of the Malleus, 
 around which the Cutis of the Meatus 
 had grown, and joined the lining of the 
 Tympanum. 
 
 After the cure of this disease, the Tym- 
 panum is exposed to the free ingress and 
 egress of the air, and the mucilaginous dis- 
 charge inspissates as the mucus of the nose 
 by the exhalation of its watery parts. By 
 this accident the patient’s deafness increases 
 at intervals, for which lie often seeks relief. 
 The practitioner, on sounding the Ear, per- 
 ceives this hardened matter, and conceiv- 
 ing, as is really the case, that it produces 
 the augmentation of deafness, is tempted 
 to remove it. Ao thing stimulative can be 
 safe, nor any rude attempts, for there is 
 great danger of reproducing the discharge. 
 Having learned that a discharge has pre- 
 existed, it will be expedient to leave it to a 
 spontaneous separation. 
 
CASES OF THE FIRST STAGE 
 
 I. 
 
 Mrs. S. had been afflicted with a puri- 
 form discharge from the Tympanum for 
 five years. On blowing’, with the nose and 
 mouth closed, air occasionally issued at the 
 Meatus, as if it escaped at a narrow orifice. 
 The discharge was very great 1 could 
 never in this instance render the bottom of 
 the meatus sufficiently visible to ascertain 
 the degree of injury which the Membrana 
 Tympani had sustained. The escape of 
 air was a sufficient demonstration of its im- 
 perfect state, a symptom which still con- 
 tinues although she is now quite well. 
 Notwithstanding the length of time, the 
 disease had not advanced beyond the first 
 stage. It jielded in the space of a month 
 to an injection, night and morning, of a 
 solution of Zincum Yitriolatum. The de- 
 gree of deafness in this instance w as trivial, 
 and she hears perfectly, after the lapse of 
 two years and three quarters since the sup- 
 
77 
 
 pression of the discharge, nor does there 
 appear the slightest disposition to a relapse. 
 The only remaining defect is a morbid 
 sensibility, which subjects her to pain when 
 exposed to loud sounds. This, perhaps, 
 arises from the inability of the muscles to 
 regulate the tension of the chain of bones 
 and the remnant of the Membrana Tym- 
 pani. 
 
 II. 
 
 Master B. had laboured under a very 
 great degree of deafness, occasioned by a 
 puriform discharge. The membrana Tym- 
 pani in this instance was injured, as air 
 could be blown out at the Meatus. This 
 case also yielded in two months to the use 
 of a solution of Zineum Yitriolatum, and 
 the patient at present enjoys nearly perfect 
 hearing. 
 
 III. 
 
 Mr. S. had been afflicted with a puriform 
 discharge from the Tympanum, proved, as 
 in the former instances, by the expulsion 
 of air at the Meatus. The deafness was 
 so great, that the tick of a watch was 
 
78 
 
 scarcely perceptible at the distance of three 
 or four inches. He ay as cured in three 
 months by a solution of Zincum Yitrio- 
 latum, when he Yvas able to distinguish the 
 tick of a Yv r atcli at rather greater distance 
 than a yard. 
 
 IY. 
 
 Mary Webb applied at the dispensary, 
 afflicted with a very great degree of deaf- 
 ness. Examining the Ears, I found a great 
 discharge from each, and air passed out at 
 the Meatus. She informed me that it had 
 been caused by the Ear-ache, that one Ear 
 had been attacked nine months before, the 
 other only two. As a certain degree of in- 
 flammatory action still remained, I ordered 
 the Ears to be fomented, and gave the pa- 
 tient laxative medicines for a few days. 
 She then commenced the use of a solution 
 of Zincum Yitriolatum, and Yvas cured at 
 the end of seven weeks. One Ear regained 
 its perfect functions, the other was consi- 
 derably inferior; but even this was capable 
 of distinguishing conversation with readi- 
 
 ness. 
 
79 
 
 V. 
 
 Mrs. B. applied for the same disease, 
 with symptoms as in the preceding cases. 
 The deafness was very great. After the 
 use of a solution of Zincum Yitriolatum for 
 four months, the discharge was stopped, 
 and her hearing almost completely restored. 
 
 VI. 
 
 Ann Thompson, a child w as brought to 
 the dispensary, after a suppuration of the 
 Tympanum in one Ear. The pus had been 
 discharged a few days preceding. I purged 
 the child briskly, and ordered the Ear to 
 be fomented for a few days. I then caused 
 a solution of Cerussa Acetata to be injected 
 three times a day. At the end of five w eeks 
 the discharge ceased. I could not perceive 
 any difference between this and the sound 
 Ear. But the patient being a child, only 
 six years old, I did not make all the trials 
 I could have wished. 
 
 VII. 
 
 Mr. T. applied two months after a sup- 
 puration of the Tympanum. The deafness 
 
80 
 
 was considerable. Air passed out at the 
 Meatus. He was cured at tbe end of two 
 months, by an injection of Cerussa Aoe- 
 tata. I ascertained that this Ear was infe- 
 rior one-fourth to the other. 
 
 VIII. 
 
 Miss B. applied on account of a puriform 
 discharge from both Ears, which had suc- 
 ceeded frequent attacks of the Ear-ache. 
 One Ear had been diseased a long time, the 
 other only a few months. The Ear last 
 attacked was cured in three w eeks, and the 
 power of hearing restored. The other is 
 considerably improved, but the discharge 
 is not yet suppressed, although astringent 
 injections have been used a long time. 
 
 C ASES OF THE SEC OVD STAGE. 
 
 I. 
 
 Mr. G. applied in consequence of deaf- 
 ness. I learned from the history which he 
 gave me, that he had been afflicted for 
 
81 
 
 many years with a puriform discharge, and 
 air had passed out at the Tympanum. At 
 this time it did not pass, and on examina- 
 tion 1 perceived Funguses at the bottom of 
 the Meatus. I attempted to extract them 
 with a small Forceps, but they would not 
 sustain the pressure. As they bled freely, 
 I destroyed them by pinches. For some 
 days I used a strong solution of Alum. 
 Finding* that the Fung'uses did not re- 
 appear under this treatment, I employed 
 the solution of Zincum Yitriolatum, as in 
 the former cases, when the discharge ceased, 
 and the patient’s hearing was remarkably 
 improved. 
 
 II. 
 
 Mr. F. Surgeon, came under my care, 
 being afflicted with two large Polypi, 
 which protruded at the Meatus. lie in- 
 formed me, that long before their appear- 
 ance he had had a puriform discharge, 
 w hich was very profuse. Some time before 
 he noticed the Polypi, the deafness had 
 become total. I extracted both with the 
 Forceps; one came out entire, the other 
 was torn, and the root remained. I pinched 
 
 M 
 
82 
 
 and tore the root at the end of twenty-four 
 hours, and forty-eight hours after, w hen the 
 congealed blood had separated, touched 
 it with the Argentum iSitratum. He left 
 me with direction to inject a solution of 
 Argentum Nitratum, and under this ma- 
 nagement the discharge stopped, and hear- 
 ing was restored. 
 
 III. 
 
 Mr. H. sought to be relieved from a large 
 Polypus, which came out at the Meatus. 
 It had appeared after a puriform discharge, 
 which had continued during eight years. 
 For a long time air j>assed out at the Mea- 
 tus in blowing his nose. This symptom 
 had ceased about the time the excrescence 
 was first observed. The Polypus was ex- 
 tracted and brought out entire. A few 
 days after he was again able to force air 
 out of the Tympanum. He used night 
 and morning an aluminous injection. At 
 the end of three months the discharge has 
 ceased; the part where the Polypus grew 
 is cicatrized, and hearing greatly restored. 
 Still this Ear is much inferior in accuracy 
 of perception to the other. He could not. 
 
83 
 
 at the time of his application, distinguish a 
 single word with this Ear, with which he 
 can now hear a person converse in a mo- 
 derate tone of voice, at the distance of 
 twelve feet. 
 
 IV. 
 
 Master B. applied in consequence of a 
 puriform discharge from the Tympanum, 
 which was extremely offensive, and was 
 often mixed with blood. Such was its 
 acrimony, that the auricle and neck were 
 excoriated by it. Air had formerly passed 
 out at the Meatus, as it would even now, 
 in the course of repeated efforts. I exa- 
 mined the Ears, and found Funguses at the 
 bottom of the Meatus. The deafness was 
 so great, that I had no expectation of af- 
 fording any relief in respect to hearing. 
 However, I undertook the supression of 
 the discharge. On account of the Fun- 
 guses, I used the Argentum Nitratum. He 
 was of a weak habit, and I therefore admi- 
 nistered the Cinchona as an auxiliary. Ho 
 applied three months ago, the discharge is 
 greatly diminished, and his hearing im- 
 proved in a remarkable degree. He can 
 
84 
 
 hear clearly what is said to him in a mo- 
 derate tone of voice at the distance of eight 
 or ten feet. 
 
 We are justified by the event of these 
 cases in drawing the conclusion, that the 
 first and .second stages are both curable, 
 and that the ultimate advantage which 
 hearing derives from the cure of tiie se- 
 cond, is nearly equal to that of the first. 
 The apparent advantage is much greater. 
 The mechanical obstacle which these ex- 
 crescences oppose to the entrance of sound 
 nearly deprives the afflicted person of his 
 hearing. The patient is therefore most 
 agreeably surpised at the success attend- 
 ing their extirpation. But in the eye of the 
 practitioner, Polypi and Funguses are only 
 incidental occurrences, and their removal 
 reduces the disease to the first stage. The 
 equality of success cannot therefore excite 
 his astonishment. 
 
85 
 
 Of the Obstruction of the Eustachian Tube. 
 
 A very great degree of deafness is pro- 
 duced by an obstruction of tbe Eustachian 
 Tube. When this lias happened, air can 
 no longer be admitted into the cavity of the 
 Tympanum,, and either the included por- 
 tion is absorbed, or c-Ise remains. In the 
 latter case, the included air, incapable of 
 yielding in any other way than by conden- 
 sation, counterbalances the pulses excited 
 by sounding bodies. In the former, the 
 pressure of the atmosphere will carry the 
 Membrana Tympani into the Tympa- 
 num. as far as it can go. in which state it 
 will rest, and cannot vibrate in any con- 
 sideraMe degree. Each hypothesis ac- 
 counts for the phenomenon. But I am in- 
 clined to think, that subsequently to the 
 obliteration of the Eustachian Tube, the 
 included air is absorbed, and the Tympa- 
 num filled with Mucous. I have found the 
 cavity in this state in two instances of dis- 
 section in which the Eustachian Tube was 
 closed. 
 
86 
 
 The obstruction of the Tube most fre- 
 quently arises from syphilitic ulcers in the 
 throat, or sloughing in the Cynanclie Ma- 
 ligna. The deafness ensues on the healing 
 of the ulcers, that is, when the obstruction 
 is complete. The descent of a nasal Poly- 
 pus into the Pharynx and enlarged Ton- 
 sils hare also been known to close the 
 tube. 
 
 If the patient blows, with his nose and 
 mouth stopped, he does not experience 
 that peculiar sensation which arises from 
 the inflation of the Tympanum. He speaks 
 only of the loss of the sense, and complains 
 of no particular symptom. The deafness 
 differs in this respect from all other species, 
 in which the patient is harassed with most 
 distressing noises which are false percep- 
 tions, arising from a diseased state of the 
 auditory nerves, or proceeding from real 
 impressions on the nerves produced by mor- 
 bid causes in the organ. 
 
 Generally the obstruction comes on in 
 consequence of some notable disease in the 
 
 ■\ - 
 
87 
 
 tin oat, and the cartilaginous extremity is 
 most commonly the seat of it. Yet it oc- 
 casionally takes place in the bony portion 
 of the Tube. It is then slower in its pro- 
 gress, proceeds from no obvious cause, and 
 consists in an inordinate ossification filling 
 up the canal. 
 
 We are destitute of a perfect diagnostic 
 symptom, by which we can be assured 
 when deafness is produced by an obstruct- 
 ed Eustachian Tube. The incapability of 
 inflating the Tympanum only renders it 
 probable. Many people who hear perfectly 
 are incapable of producing this sensation, 
 at least in a great many trials. We are, 
 therefore, compelled to trust to the pa- 
 tient’s account. This will be sufficient 
 when the obstruction has been preceded 
 by an ulceration or disease of the throat. 
 Otherwise, the patient’s history will not 
 always conduct to the discovery. 
 
 The world is indebted to the observation 
 and penetration of Mr. Astley Cooper, for 
 restoring the hearing which this obstruc- 
 tion destroys. He had observed in sup- 
 
88 
 
 purations of the Tympanum, which had 
 injured and even destroyed the Membrane 
 Tympani, that the sense of hearing was 
 only impaired, not totally lost; and that 
 the degree of deafness, when the Mem bran a 
 Tympani was only injured, by no means 
 equalled that produced by the obstructed 
 tube. Reflecting on this, he was induced 
 to consider that a small puncture of the 
 Membrana Tympani would be of trivial 
 detriment even to a sound Ear, and in this 
 instance would be the means of restoring 
 to the Organ the exercise of its functions. 
 This happy expedient he himself executed 
 with great success, a success fully con- 
 firmed by a similar result of the operation 
 in other hands. 
 
 The operation is performed by passing 
 an instrument into the Meatus, and push- 
 ing it through the anterior and inferior part 
 of the Membrana Tympani. It is unneces- 
 sary to state the reason for making the 
 puncture in this place. The position of 
 tliQ Manubrium of the Malleus evidently de- 
 mands this precaution. A little crack will 
 immediately be perceived similar to whaf 
 
89 
 
 is occasioned by the puncture of parch- 
 ment, more particularly if the tube be closed, 
 as the sound will then be more acute, from 
 the rapid entrance of the air through a 
 narrow aperture. 
 
 The instrument ought not to penetrate 
 far into the Tympanum, lest it should 
 puncture its vascular lining, as the escape 
 of blood into the cavity would for a short 
 time frustrate the operation, even if it 
 should ultimately be successful. 
 
 When the puncture has been successfully 
 made, the patient is instantaneously re- 
 stored to perfect hearing. The effect of 
 the operation is the immediate substitution 
 of the small hole in the Membrana Tym- 
 pani for the Eustachian Tube; and the air 
 being admitted into the Tympanum, the 
 mobility of the Membrana Tympani returns, 
 and the action of the machinery of the 
 Tympanum is re-established. 
 
 The only obstacle to the complete suc- 
 cess of this puncture is its tendency to close. 
 For this reason it is often necessary to 
 
 N 
 
90 
 
 make rather a large hole in the membrane 
 before you can insure the patient against 
 the recurrence of the deafness. But a large 
 hole diminishes the perfection of the sense. 
 Tension is the state essential to the Mem- 
 brana Tympani. This tension is not dimi- 
 nished by a small perforation. But if the 
 Membrana Tympani be much lacerated 
 or detached at its circumference, the ten- 
 sion will be lessened; yet even then the 
 patient receives a striking benefit. To this 
 imperfection we must however submit, and 
 I am inclined to think a larger opening 
 expedient than what can be made by a 
 simple perforation with the instrument pro- 
 posed by Mr. Cooper. 
 
 It has already been observed, that a per- 
 fect diagnostic symptom is a desideratum 
 in this species of deafness. If a deafness 
 be accompanied with noise, it is highly 
 improbable that an obstructed Eustachian 
 Tube is the cause of it. It certainly is 
 not, if the Tympanum can be inflated. 
 
 But there are some dubious cases of 
 deafness in which a surgeon would re- 
 
91 
 
 luctantly refrain from taking the chance of 
 this operation. In such he cannot do wrong 
 by piercing the Membrana Tympani. It 
 has been found that its disposition to close 
 is very great, even when the Eustachian 
 Tube is impervious, and this is still greater 
 when the tube is open. It is generally re- 
 united in three or four days, but if the open- 
 ing should remain fistulous, no injury re- 
 sults from it. 
 
 It would be superfluous to introduce the 
 particular cases of success which are re- 
 lated by Mr. Cooper. They may be found 
 in his paper published in the Philosophical 
 Transactions for 1802 . But I am authorized 
 by him to say, that Mr. Bound, whose 
 case is there mentioned, continues to enjoy 
 the relief he at first experienced. 
 
 The following case, which came under 
 my own care, will illustrate what lias been 
 advanced respecting the closing of the 
 puncture. 
 
 Mr. Gr. K. had been deaf for thirty years. 
 I could scarcely make him sensible of what 
 
92 
 
 I addressed to him, even when I spoke 
 directly into his Ear, in the loudest tone 
 of voice. The deafness had succeeded the 
 loss of a part of the Palate by Syphilis. 
 I had no doubt from the manner in which 
 he had become deaf, that this was a case of 
 obstructed Eustachian Tube. 
 
 I placed him in the sun, and passing a 
 probe to the anterior part of the Membrana 
 Tympani, made a small perforation. A 
 crack immediately ensued, and in the space 
 of a few seconds he heard distinctly the 
 chirping of sparrows on a tree at a great 
 distance. In a word, his hearing was per- 
 fectly restored. 
 
 In the space of three days his deafness 
 recurred, and at the end of a week I again 
 punctured the • Membrana Tympani with 
 the same result. Before the end of a week 
 the deafness again recurred, and at the end 
 of a fortnight, I pierced the Membrana 
 Tympani a third time with equal success. 
 
 The opening was now somewhat larger: 
 but the deafness relapsed in a fortnight. I 
 
93 
 
 did nothing for a few weeks. Seeing no 
 amendment, I passed a probe through the 
 Membrana Tympani, and extended the 
 opening to the circumference. He was 
 again restored, but not so perfectly as be- 
 fore. This opening I believe remains per- 
 fect at the present time. 
 
 ON THE DISEASES OF THE INTER- 
 NAL PART OF THE EAR. 
 
 The nature of the deafness which arises 
 from the Diseases of the Internal part of the 
 Ear, is at present completely obscure, from 
 our great ignorance of the morbid changes, 
 which are the immediate cause of the defect. 
 If we reflect on the component parts of the 
 Labyrinth, we cannot refrain from coming 
 to the conclusion, that it originates in a want 
 of sensibility in the nerve, some alteration 
 in the structure of the Membranes on which 
 the nerve is expanded, or change in the 
 properties of that fluid which is contained 
 in the Membranes, and is the immediate 
 agent in impressing the sentient extremities 
 
94 
 
 of the nerve. On the latter head, as we 
 are informed by Mr. Cline, he found in the 
 dissection of the Ear of a person horn deaf, 
 that the labyrinth, instead of its aqueous 
 fluid, contained a thick caseous substance. 
 This must have been incapable of undula- 
 ting in the cavities of the labyrinth, and is 
 fully adequate to account for the total ab- 
 sence of the sense. 
 
 That a total deafness may exist without 
 any defect in the mechanism of the exterior 
 parts of the Ear, without any defect in the 
 membranous structure on which the nerve 
 is expanded, in the water which it contains, 
 or in the nerve itself, at least as far as can 
 be traced by the eye, I have myself ascer- 
 tained by dissection. 
 
 The first instance was the Ear of a child, 
 from the Asylum for the deaf and dumb, 
 which died at Guy’s Hospital. The disease 
 was such as caused the inspection of the head 
 after death. Mr. Swift, of Oxford, a student 
 at Guv’s, cut out for me the Os Tern- 
 poris. I dissected the Ear with the minutest 
 attention, and could not perceive the slight- 
 
95 
 
 est defect in the structure of the parts. 
 The nerve was apparently perfect, and I 
 think we must admit that the deafness arose 
 from an original want of power in the nerve, 
 caused by a deviation from its natural struc- 
 ture too minute for our means of inspection, 
 or a deficiency of that incrutable principle 
 on which its functions depend. 
 
 The second was a dissection of a man’s 
 Ear, who died of a cancer in Guy’s Hospital. 
 He was a patient of Mr. Cooper’s, and had 
 been deaf for many years. I was equally 
 unable to detect in these ears any organic 
 disease, and as I knew the symptoms were 
 such as are called nervous deafness, I paid 
 the utmost attention to the condition of the 
 labyrinth. 
 
 The whole class of the diseases to which 
 the internal part of the Ear is subject may 
 be denominated nervous deafness. In this 
 sense it is a generic term, and signifies every 
 disease the seat of which is in the nerve or 
 parts containing the nerve. But in its ge- 
 neral acceptation the term is more specific. 
 
96 
 
 The general character of this class is 
 great changeableness. The symptoms are 
 noises in the head of various kinds, the 
 murmuring of water, the hissing of a boil- 
 ing tea-kettle, rustling of leaves, blowing 
 of wind, £jc. Other patients speak of a 
 beating noise corresponding with the pulse, 
 and increasing by bodily exertion in the 
 same degree as the action of the hearts 
 The cause of this impression is certainly the 
 pulsation of the Arterial system, but I con- 
 fess myself at a loss to explain what the 
 change is which renders the organ suscept- 
 ible of this impression. Nor can I at all 
 determine whether the small arteries which 
 ramify in the interior of the labyrinth are 
 the immediate agent, or the internal Ca- 
 rotid, which passes close beneath the Coch- 
 lea. Whatever be the cause, the species is 
 distinct, nor is the patient who has this 
 symptom, affected with the various noises 
 mentioned before. 
 
 All these confused and harassing sounds 
 are false perceptions in the organ, but they 
 arise less frequently (if I may so say) in the 
 
97 
 
 nerve itself, than from the condition of the 
 parts about the nerve. I formed this con- 
 clusion from observations on syphilitic deaf- 
 ness, of which the following is a striking 
 instance, and it evidently depended on 
 some change in the labyrinth. 
 
 Mr. B. applied to me, in a case of ex- 
 treme deafness. He complained of various 
 sounds, as the blowing of wind, rustling of 
 leaves, &jc. which were so loud, that he 
 often could with difficulty disbelieve their 
 reality. I examined the Ear, and there 
 was no wax, and on blowing his nose, he 
 inflated the Tympanum. I considered it 
 a case of nervous deafness, and despaired 
 of rendering him any service. But as it 
 was not of long standing, and he laboured 
 under a great heaviness and dejection of 
 countenance, and had a white tongue, X 
 was tempted to try how far the deafness 
 might he relieved by the mitigation of the 
 constitutional disorder. I therefore pre- 
 scribed. In about three weeks he com- 
 plained of having a cold and sore throat. 
 I found a syphilitic ulcer. On putting 
 
 him under a course of mercury, the ulcer 
 
 o 
 
98 
 
 healed in a fortnight. But the patient had 
 taken mercury five -weeks before his hearing: 
 was much improved. In fine, he recovered 
 his hearing completely, and all the symp- 
 toms subsided. 
 
 In two or three other cases of syphilitic 
 deafness the symptoms have been precisely 
 the same, and the event a cessation of the 
 symptoms and recovery of hearing. 
 
 When I reflected on the event of these 
 cases, I could not but consider that some 
 change had been produced in the structure 
 of parts adjacent to the nerve, and had 
 been the proximate cause of the symptoms, 
 rather than that the nerve itself had been 
 affected. It is the most reasonable infe- 
 rence, as the mercury, which cured it, is 
 more calculated to exhaust than impart 
 energy to the nerves. 
 
 Being forcibly struck with the congruity 
 between deafness produced by Syphilis and 
 the concomitant symptoms of nervous deaf- 
 ness, I could not avoid concluding, that 
 although the remote cause he different, the 
 
99 
 
 proximate cause is the same in each. Ana- 
 logous to this is defective vision, arising 
 from opacity, which may result from com- 
 mon inflammation or specific. In this case 
 the immediate cause is the deposition of 
 Lymph. 
 
 The change from the specific cause in 
 either instance is most manageable, because 
 we are furnished with a remedy, which, as 
 soon as its action is produced, arrests the 
 progress of the disease. But as the opacity 
 in a syphilitic ophthalmia is often too far 
 organized to be absorbed, so in syphilitic 
 deafness, when the syphilis is cured, the 
 effect is often irremovable, and the injury 
 to the function of the affected organ per- 
 manent. There is a period, therefore, at 
 which syphilitic deafness is irremediable, 
 and this is more remarkably the case with 
 nervous deafness. 
 
 Having satisfied myself that the proxi- 
 mate cause of syphilitic and nervous deaf- 
 ness was the same, I was determined to try 
 the success of an analogous treatment in a 
 recent case of nervous deafness. I was soon 
 
100 
 
 furnished with an opportunity of bringing 
 tills to the test. 
 
 CASES OF INCIPIENT NERVOUS 
 DEAFNESS, 
 
 SUCCESSFULLY TREATED. 
 
 J. 
 
 J. Walton applied at the dispensary for 
 relief. He had been extremely deaf for 
 two months. The Meatus contained little 
 wax, and he could inflate the Tympanum. 
 He complained of noises in his head, such 
 as I have described above. His deafness 
 was so great, that I could scarcely make 
 him hear what I said. lie was a robust 
 man, and plethoric. — I put him on a most 
 rigid diet, and gave active cathartics three 
 times a week. For the first fortnight the 
 doses were Calomel Gr. viij. at night, and 
 Natron Vitriolat. Oz. iss. in the morning. 
 Blisters were also applied behind the Ears 
 three times successively at intervals of a 
 
101 
 
 week. He continued on tills plan for six 
 weeks, the cathartics being regulated accor- 
 ding to circumstances. His hearing was 
 now restored, but slight noises still remain- 
 ed. He was much reduced, and I gave 
 him small doses of Calomel every night, 
 and Sarsaparilla twice a day for a fortnight. 
 The noises had now left him, he was put on 
 liis usual diet, and took Cinchona. At the 
 end of ten weeks he was perfectly well. 
 
 Ill 
 
 J. Clinch, a lad, applied at the dispensary, 
 afflicted with a very great degree of deafness. 
 The noises in his head were trivial, com- 
 pared with the other case. He had little 
 wax, and could inflate the Tympanum. 
 He could hear a watch tick at only three 
 inches from his Ear. I applied blisters be- 
 hind the Ears four times successively, at 
 intervals of a week. He took every night 
 Calomel Gr. if. twice a week a solution of 
 Magnesia Vitriolata. At the end of five 
 weeks he heard a watch tick at the distance 
 of a } 7 ard. He was a good deal reduced, 
 and I changed the plan to the Cinchona. 
 Tie left me at the end of two months, w hen 
 
102 
 
 lie could distinguish the tick of a watch at 
 rather greater distance than a yard. 
 
 III. 
 
 Wm. Higgins, a boy, applied at the 
 dispensary. He had been very deaf six 
 weeks. He had little wax, could inflate the 
 Tympanum, and had no catarrhal symp- 
 toms. He was always complaining to his 
 mother of singing and noise in his Ears. 
 He was treated with three blisters in suc- 
 cession, at intervals of a week; took Calomel 
 Gr . iss. every night, and a solution of Mag- 
 nesia Yitriolata twice a week. He wag 
 perfectly cured at the end of five weeks. 
 
 IV. 
 
 Wm. Bygrave had been deaf for two 
 months with singing and noise in his Ears. 
 The symptoms were the same as in the 
 other instances. His health was in other 
 respects very good. The diminution of 
 hearing was much less than in the other 
 cases, and yielded to the use of two blisters, 
 brisk cathartics, and rigid diet, in a little 
 more than three weeks. 
 
iOS 
 
 V. 
 
 Win. Harvey applied at the dispensary. 
 He had been exceedingly deaf for six 
 months; otherwise in perfect health. In 
 blowing his nose, air passed into the Tym- 
 panum, §c. The noises in his head were 
 perpetual, and harassed him much. He 
 was treated very much in the same manner 
 as the other cases. He experienced but 
 a trifling relief at the end of three weeks. 
 I almost despaired of success, and was 
 principally induced to persevere by his 
 anxiety to be cured. He continued the 
 blisters for two months, gradually growing 
 better in that time, so as to hear a w atch 
 tick at about tw o yards, although when he 
 first applied he w as obliged to place it in 
 contact with his Ear. 
 
 VI. 
 
 3. Kirwan, a lad, applied at the dispensary 
 on account of a deafness of some months. 
 His symptoms w ere precisely as those men- 
 tioned in the former cases. His general 
 health perfect. He was cured on the same 
 plan as the others, in three weeks. 
 
104 
 
 I shall not weary the reader with the 
 recital of any more cases. These are suffi- 
 cient to establish the point that the incipient 
 state of these symptoms may be relieved, 
 and that a strict antiphlogistic treatment 
 and means of promoting absorption ought 
 to he employed. 
 
 Confirmed nervous deafness is, without 
 doubt, hopeless, but I know not a priori 
 how to determine, when attempts are vain. 
 This does not altogether depend on the 
 time but the decree of mischief done to the 
 organ, and the periods at which it becomes 
 incurable must he various. The case of 
 longest standing is that of V.in, Harvey. 
 This did not yield until the plan had been 
 carried to an extreme, to which few patients 
 would be inclined to submit. Beyond this 
 time I should think irremediable. 
 
 My object is to direct the attention of the 
 practitioner to the commencement of this 
 species of deafness. When early applica- 
 tion is made, it behoves him to take the case 
 seriously in hand, for no time is to be lost 
 
105 
 
 and active means in the beginning will 
 often succeed. 
 
 It is far from my inclination to excite a 
 hope that old cases of this species of deafness 
 admit of cure. I have never seen or heard 
 of any cured by any plan of treatment 
 whatsoever, and as to the various vaunted 
 remedies with which the public prints are 
 daily teeming, 1 know them to be abso- 
 lutely inefficacious, and often prejudicial. 
 ^*^*^*****^ 
 Mr. Curtis divides the Diseases of the In- 
 ternal Ear into the constitutional and local, 
 Or such as influence it from a morbid condi- 
 tion of the brain or other parts of the body, 
 and such as arise from a change in its own 
 particular structure. 
 
 “ Of all the causes of deafness,” he ob- 
 serves, “ that which proceeds from an orga- 
 nic affection of the brain is the most danger- 
 ous. In apoplectic cases, with faultering of 
 speech and blindness, we find deafness also 
 produced by the general affection of the 
 head. But worst of all is the case where a 
 tumour of the brain compresses the origan 
 
 r 
 
106 
 
 of the nerves; for here the deafness is com- 
 plete, and no impression can be conveyed 
 through the organ to the mind.” 
 
 “ A tumour, however, in the vicinity of 
 the organs of hearing, though it runs its 
 course, and proves fatal in the end, has ra- 
 ther a contrary effect: and even while the 
 pupils are dilated, and there is every appear- 
 ance of pressure on the brain, a morbid 
 acuteness takes place, in consequence of the 
 surrounding inflammation. Indeed, the au- 
 ditory nerve often becomes acutely sensible 
 in disease, or the patient suffers from acute- 
 ness of perception, or has a tinitus aurium, 
 or singing of the ears, analogous to the flash- 
 es of light which sometimes affect the eves 
 in total blindness, and which those experi- 
 ence who are blind of cataract. So morbid- 
 ly acute does sensation become in some per- 
 sons under disease, that the least motion of 
 the head will excite a feeling like the ring- 
 ing of a great bell close to the ear.” 
 
 “ In delirium also, in vertigo, in apoplexy, 
 and in hysteria, the increased sensibility of 
 the organ becomes a painful sensation. In 
 
107 
 
 paralytic affections of the face, we find there 
 is deafness of the corresponding ear, if the 
 affection of the nerve be near the brain; 
 which is explained by the intimate connex- 
 ion between the auditory nerve and the com- 
 municating one of the face. From observ- 
 ing the course of the latter nerve through 
 the temporal bone, and its connexion in the 
 Tympanum, we know why, in violent tooth- 
 ache, and in tic doule'reux, we find the 
 Eustachian Tube and the root of the tongue 
 affected.” 
 
 “ The Ear is also sometimes affected by 
 sympathy, from foulness of stomach and 
 bowels; and the same reason may be assigned 
 for the symptom of Hypo'chondriasis — that 
 they are affected with strange sounds, and in 
 the case of intestinal worms, we find mur- 
 muring, and ringing of the Ears a symp- 
 tom.” 
 
 “ Deafness in acute fever is considered a 
 favourable sign; as it argues, according to 
 the old theory, a metastasis or translation of 
 the morbific matter; or rather, according to 
 modern opinion, it shews a diminution of 
 
108 
 
 morbid sensibility of the brain. The accu- 
 mulation of blood in the vessels of the brain, 
 or those surrounding the auditory nerve, 
 will also produce deafness, and unusual sen- 
 sations of the Ear. This we find instanced 
 in suppression of the menses, and in hem- 
 orrhoids, indigestions, &jc. in which cases 
 it is found preceded by vertigo and head- 
 ache.” 
 
 “ In comparing the diseases of the Ear 
 and the Eye, we find a considerable analogy 
 subsisting between them; but in those of 
 the eyes there is one advantage, that the 
 transparency of its humours is a leading 
 mark to direct us, which we do not possess 
 in the case of the Ear; but in judging of the 
 diseases of the Internal Ear, we should al- 
 ways endeavour to determine, whether it is 
 in the seat of sense or in the brain that the 
 real affection lies: otherwise our attempts to 
 relieve will be ineffectual.” 
 
 “ All the forms of nervous deafness may 
 be considered as peculiar modifications of 
 constitutional disease, affecting the nervous 
 system in general, and connected with that 
 
109 
 
 state which constitutes tlie hypochondriac 
 and hysterical habit. The general morbid 
 disposition is here extended to a particular 
 sense, and by viewing it in this light the 
 change of the constitutional affection must 
 form the basis of the cure. It is by consi- 
 dering it in this just point of view that pro- 
 per principles of treatment can only be adopt- 
 ed, and that much may be done to remove 
 this species of the complaint. The hysteri- 
 cal spasm of the throat and primse vise be- 
 comes naturally, from the connexion and 
 sympathy of nerves, communicated to those 
 of the Ear, and deafness in most cases is a 
 never failing symptom with hysterical pa- 
 tients. In the same maimer that torpor of 
 the stomach and primse vise, so characteris- 
 tic of hypochondriasis, occasions a dull sen- 
 sation and torpor of the auditory nerve, and 
 produces that noise and confused impres- 
 sion so often complained of in hypochon- 
 driasis.” 
 
 “ A wide field therefore, opens here for 
 new principles of treatment, by attacking the 
 constitutional cause, and that much relief 
 may be obtained by the adminstration of 
 
110 
 
 constitutional means, experience daily evin- 
 ces. It is from not keeping that analogy 
 in view that nervous deafness is sg formida- 
 ble to most Surgeons.” 
 
 “ These cases of nervous deafness, when 
 our Ear only is affected, are in general ren- 
 dered worse by the conduct of the patients 
 themselves; for when the organ of one side 
 is injured, we hear so much better with the 
 other, that we only attend to the sensation 
 conveyed by it, and neglect the duller sensa- 
 tion. The effect of this is, that the diseased 
 ear becomes worse, and the same conse- 
 quence arises as that which takes place in the 
 Eyes by squinting.” 
 
 “ In attending to the treatment of ner- 
 vous deafness, if the practitioner is early ap- 
 plied to, and the disease is still in its first 
 stage, it may be considered in general as cu- 
 rable; and even cases of long-standing, when 
 properly treated, admit of considerable re- 
 lief.” 
 
 “ A strict antiphlogistic course, if the pa- 
 tient be able to bear it, will often prove sue- 
 
Ill 
 
 cessful; namely, powerful saline cathartics, 
 of which the best is the vitriolated magne- 
 sia: the doses should be repeated as often 
 as the strength of the patent will admit; and 
 in the intermediate time small doses of the 
 submuriate of mercury are to be admin- 
 istered to promote absorption, by taking off 
 any thickening of the parts, which is apt to 
 impede the due performance of the functions 
 of the organ.” 
 
 “ This practice will in incipient cases suc- 
 ceed; and, if not completely, will at least pal- 
 liate the predominant symptom, and in all 
 cases it ought to have a fair trial, for deaf- 
 ness should never a priori be considered as 
 incurable.” 
 
 “ With respect to the application of topi- 
 cal remedies to the Ear, gentle stimulants, 
 in form of linament, as a portion of the es- 
 sential oils mixed with oil of almonds, may 
 be beneficially introduced into the Ear, 
 where, being retained, they will serve as a 
 substitute for the natural secretion, and at 
 the same time increase the sensibility of the 
 passage. All the advertised nostrums are 
 
112 
 
 preparations of this kind; and, so far as they 
 supply the secretion, and gently stimulate 
 the passage, in some cases they may be use- 
 ful: but as to the notion that they are to re- 
 move an organic affection of the part, the 
 various species of which have been descri- 
 bed, it only shows the complete ignorance of 
 those who expect success from such inade- 
 quate means of relief.” 
 
 As so little can be done by medicine in 
 confirmed cases of deafness of long "stand- 
 ing, arising from imperfect organization of 
 the Ear, Mr. Curtis has with much pains 
 collected a variety of contrivances to assist 
 hearing, many of which he has obtained from 
 the Continent, in order to give all possible 
 relief in such distressing cases. 
 
 “ The newest inventions of this kind, are 
 the artificial Ears lately introduced from 
 France, w here they were originally manu- 
 factured. By being closely adapted to the 
 Ear, they increase the collection of sound; 
 but besides that, there is an additional force 
 w r anted to transmit it through the passage. 
 In this respect, the French invention is de- 
 
113 
 
 ficient; to remedy its defect Mr. Curtis lias 
 added a small tube, which, by contracting 
 the passage, will occasion the sound to en- 
 ter with greater impetus. This invention 
 is found very convenient, in consequence 
 of the substitutes being* applied over the 
 natural Ear, which they are made to resem- 
 ble. 
 
 The Spanish Ears also, made of shells 
 answer very well: but, at the same time, it 
 is worthy of remark, that these mechanical 
 contrivances, although found to be more ser- 
 viceable than any thing of the kind in gene- 
 ral use, yet do not apply with equal success 
 in all cases; and there are, in fact, cases in 
 which no mechanical contrivance can be of 
 use- 
 
 With some patients the German Silver 
 Ears answer better than any others; but are 
 objected to by many, on account of their 
 weight, and being more conspicuous than 
 the French Ears; it also being necessary 
 that they should be fixed by a spring, which 
 goes over the head. 
 
 Q 
 
114 
 
 The French Ears, being made of a light 
 substance, where they answer the purpose, 
 are generally preferred. 
 
 Mr. Curtis has also invented a hearing- 
 trumpet, forming a parabolic conoid, on the 
 same principle as the speaking trumpet 
 used at sea, which is so well known to answer 
 the purpose in extending the impression of 
 sound. It has this convenience, that it 
 shuts up in a small case for the pocket. 
 
 Cases extracted from Mr. Curtis' zcork, il- 
 lustrative of the Treatment of Constitu- 
 tional or Sympathetic Deafness. 
 
 & “ Sarah Gjreen, five years of age, was 
 brought by her mother to the If ova l Dis- 
 pensary on the 3rd day of May. The child 
 appeared very deaf, and of a listless aspect: 
 by her mother’s account she passed restless 
 nights, gnashed her teeth during sleep; ap- 
 petite various, at one time indifferent, at ano- 
 ther voracious. The child’s appearance was 
 sickly, the eye languid and heavy, counte- 
 nance pale, and the upper lip somewhat 
 tumeffed; the bowels were irregular, and the 
 stools dark and offensive.” 
 
115 
 
 Suspectingfrom the deranged state of the 
 digestive functions, that the deafness might 
 he sympathetic of this affection, I felt inclin- 
 ed to try the effects of gentle emetics, re- 
 peated twice a week, with calomel interven- 
 ing. I shortly had the satisfaction to find 
 the stools less foetid, the appetite more natu- 
 ral, and the general health and appearance 
 of the child to improve; as these changes for 
 the better took place, a corresponding alter- 
 ation in the local affection of the Ear ac- 
 companied these salutary and flattering 
 changes in the constitution. In short, with 
 a restoration to good health, there was 
 also a complete recovery of the sense of 
 hearing. Ko worms were observed to pass 
 by stool, and the child remains perfectly 
 well.” 
 
 “In about a week after the last case was 
 dismissed cured, Master Macnamara, a fine 
 boy, about nine years of age, was brought 
 to my house labouring under similar symp- 
 toms. From the efficacy of emetics in the 
 case of Sarah Green I had recourse to them 
 in this; and without detailing the symptoms 
 at length, and the progressive and siraulta- 
 
116 
 
 neons disappearance of the disorder of the 
 system and the sympathetic affection of the 
 Ear, suffice it that their use appeared equal- 
 ly appropriate, and their effect was equally 
 beneficial.” 
 
 “ Master , the son of a worthy Ba- 
 
 ronet, was exceedingly deaf when brought 
 to me. He too was of a pale complexion 
 and languid appearance, ground his teeth 
 when asleep, and often when awake pick- 
 ed his nose; his bowels and appetite were 
 irregular; stools foetid and dark-coloured, 
 belly hard and tumid, and frequently he 
 complained of griping pains about the um- 
 bilicus.” 
 
 Emetics were had recourse to without 
 effect, but as the symptoms of w orms were 
 unequivocal, he was put on a course of 
 strong anthelmintics, and vermes of the 
 lumbrici kind were passed in abundance. 
 The general health shortly after this im- 
 proved daily, and what proves that the hear- 
 ing was affected sympathetically, was the 
 restoration of this sense on the other com- 
 plaints, being got rid of.” 
 
117 
 
 “No topical means were applied in these 
 cases, but the cure was wholly affected by 
 having detected and remedied the remote, 
 yet indubitable source of the deafness.” 
 
EXPLANATION 
 
 OF 
 
 THE PLATES. 
 
 PLATE I. 
 
 This Figure represents a section of the Cranium and Face, 
 made for the pupose of shewing, in one view, the Meatus 
 Externus, the Membrana Tympani, and Eustachian Tube, 
 that the relative position of these parts may be distinctly 
 comprehended. 
 
 The right side of the Face is removed by means of two 
 sections, a longitudinal and a transverse, the former of which 
 is made a little on the right of the Septum Nasi, the latter 
 a little before, and parallel with the Meatus Externus. The 
 two sections incline towards each other, and meet at an ob- 
 tuse angle. 
 
 The right side of the Velum Palati Mollis is separated 
 from the bony palate, and the Pharynx preserved and dis- 
 played in a lateral view. 
 
 The anterior part of the Meatus Externus is opened from 
 the beginning of the Tragus to the Membrana Tympani, 
 

PI II 
 
 
i 19 
 
 which lies at the bottom, and separates it from the Tympa- 
 num. The anterior part of the Eustachian Tube is also op- 
 ened, and a probe lies in it, and passes from its orifice in the 
 upper and lateral part of the Pharnyx into the Tympanum, 
 which is left unopened. 
 
 a. The Meatus Externus. The letter is placed exactly 
 at the junction of the bone and cartilage which compose 
 this Canal. 
 
 b. The Membrana Tympani. 
 
 c. The Eustachian Tube, with a probe in it. The head of 
 the probe serves to mark the aperture of the right nostril in 
 the Pharynx/ 
 
 PLATE II. 
 
 Fig. I. 
 
 This Figure represents an interior view of the Membrana 
 Tympani and Eustachian Tube, which have been divided 
 from the petrous portion of the Os Ternporis by a transverse 
 section, and of the lateral part of the nostril divided from the 
 Septum Nasi, with a portion of the Velum Palati Mollis and 
 Pharynx annexed. It is given with the design of shewing 
 the relative position of the aperture of the Eustachian Tube 
 to the Membrana Tympani, and its oblique course from the 
 Tympanum to the spot where the Nostril and Pharynx com- 
 municate. 
 
 a, The Eustachian Tube. 
 
 b. The Membrana Tympani. 
 
120 
 
 c. The Malleus attached to the Membrana Tympani. 
 
 d. The Chorda Tympani passing over the Malleus and 
 Membrana Tympani. 
 
 e. The section of the Pharynx. 
 
 /. The section of the Velum Palati Mollis. 
 
 Fig. II. 
 
 This Figure represents a dissection of the Os Temporis 
 to shew the chain of bones between the Membrana Tympani 
 and Vestibule, precisely in their proper situation; for the 
 bone is so cut that the Stapes rests on the lower part of the 
 Fenestra Ovata, the Malleus is attached to the Membrana 
 Tympani, and the Incus is in its articulation near the aper- 
 ture of the Mastoid cells. 
 
 a. The Malleus. 
 
 b. The Incus- 
 
 c. The Stapes. 
 
 Fig. III. 
 
 This Figure represents a dissection of the Ear, in which 
 the anterior part of the Meatus Externus is cut off, and the 
 Tympanum opened. The Eustachian Tube is also opened, 
 and the view of it is the same as in Plate I. This Figure 
 shews the Membrana Tympani, the Malleus, and Tensor 
 Membranse Tympani attached to it. As the Tympanum is 
 opened, the size of this cavity may be judged of, as well 
 as the degree of convexity which is proper to the Mem- 
 brana Tympani, circumstance best observed in a lateral 
 view. 
 
 a. The Meatus Externus. 
 

pi. m 
 
b. The Membrana Tympani. 
 
 c. The Eustachian Tube. 
 
 d. The Malleus. 
 
 e. The Tensor Membranse Tympani, sending its tendon 
 through a little foramen of bone, and inserted into the Manu- 
 brium of the Malleus. 
 
 PLATE III. 
 
 Fig. I. 
 
 This Figure represents the Foetal Os Temporis; to shew 
 the slender bony ring that contains the Membrana Tympani. 
 This ring is elongated by subsequent ossification into that 
 considerable process of the adult bone, called by Osteologists 
 the Meatus Auditorius Externus. 
 
 a. The Ring of bone. 
 
 b. The Membrana Tympani. 
 
 Fig. II. 
 
 This Figure represents in different positions the indivi- 
 dual bones, which form the chain of connexion between 
 the Membrana Tympani and the Membrane of the Vesti- 
 bule. 
 
 1. A view of the Malleus, as seen within the Tympa- 
 num. 
 
 a. The Manubrium. 
 
 b. The Head. 
 
 c. The Processus Gracilis. 
 
 R 
 
122 
 
 2. A View of the Malleus, as seen from the Meatus Ex- 
 ternus. 
 
 a. The concave portion of the Manubrium, the extremity 
 of which reaches the centre of the Membrana Tympani. 
 The whole of this surface is attached to the Membrana Tym- 
 pani. 
 
 b. The articular surface on the head for its junction with 
 the Incus. 
 
 3. A view of the Side of the Incus, that faces the Mem- 
 brana Tympani. 
 
 a. The longer Crus. 
 
 b. The shorter Crus. 
 
 c. The articular surface for its junction with the Mal- 
 
 4 . A View of the Side of the Incus, that faces the Laby- 
 rinth. 
 
 • a. The longer Crus, having the Os Orbiculare on its ex* 
 tremity. 
 
 b. The shorter Crus, which articulates in a depression 
 close to the aperture of the Mastoid Cells. 
 
 j5. A View of the Stapes, as seen by a person who holds 
 it with the base towards him, and the straight part of the 
 base lowermost, and looks at the same time into the hollow 
 of its Crura. 
 
 a. The Head. 
 
 b. The Base. 
 
 c. The two Crura, of which the most incur vated lies to- 
 wards the Mastoid process. 
 
 6. A View of the Incus and Stapes articulated to shew the 
 intervening Os Orbiculare. 
 
 Ieu3. 
 
 a. The Os Orbiculare. 
 
123 
 
 7. A View of the whole chain of bones, articulated, with 
 the Tensor Membranae Tympani, adhering to the Manu- 
 brium of the Malleus. 
 
 Fig. III. 
 
 This Figure represents the exterior portion of the Mas- 
 toid process and Tympanum, both having been divided by 
 a vertical section, to exhibit the Mastoidal cells, the inter- 
 nal surface of the Membrana Tympani, and the Portio 
 Dura of the Auditory Nerve, turned out of the Stylo-mas- 
 toid canal. The section is continued beyond the Tympa- 
 num, and cuts the Os Sphenoides in such a manner as to 
 make a section of the Foramen Spinosum, the Foramen 
 Ovatum, and to separate the Ala Minor from the body of 
 the Os Sphenoides directly within the Foramen Opticum 
 By the section of the Os Sphenoides the Inferior Maxillary 
 nerve is laid bare, and the angle of the lower jaw remains 
 to shew one of the branches of this nerve, viz. the Dental, 
 entering the Dental canal. The object is to shew tke 
 Chorda Tympani, and its connexion with the sublingual 
 branch of the Inferior Maxillary and the Portio Dura of 
 the Auditory Nerve. On this account both these nerves 
 are dissected and displayed. The precise course of the 
 Chorda Tympani through the Tympanum is demonstrated 
 by the preservation of the Malleus and Incus in their proper 
 situation.. It lies on the Membrana Tympani, passing over 
 the Manubrium of the Malleus, between it and the longer 
 Crus of the Incus. 
 
 a. The Mastoidal cells. 
 
 b. The Membrana Tympani. 
 
 c. The Portio Dura of the Auditory Nerve, turned out 
 of its canal; and the little twig of the Chorda Tympani 
 going off through the bone to enter the Tympanum is 
 marked <*. 
 
124 
 
 d. The Inferior Maxillary Nerve. 
 
 e. The Dental branch. 
 
 f. The Sublingual branch. 
 
 g. The Chorda Tympani. 
 
 Fig. IV. 
 
 This Figure represents the interior portion of the Mas- 
 toid Process, the interior part of the Tympanum, viz. that 
 part which is opposite to the Membrana Tympani, and the 
 Eustachian Tube, connected with the Tympanum. This 
 View is given by a section similar to that of the last Figure; 
 and allowing for the variation of different subjects, and a 
 slight deviation of the Saw, the two portions laid together 
 would compose a complete Ear. The Stapes remains in 
 situ , fixed in the Fenestra Ovata, and the Tendon of the 
 Stapedus Muscle is seen inserted into its head. Its base is 
 concealed in the hollow of bone that bounds the Fenestra 
 Ovata. The Fenestra Rotunda is visible, situated a little 
 below the Stapes. This section also exposes the Portio 
 Dura of the Auditory Nerve, which winds between the 
 Tympanum and Mastoid cells. At one part, the Horizon- 
 tal Canal is close to it, and is here opened, that the proxi- 
 mity may be observed. The Internal Carotid Artery is also 
 dissected and introduced. Its course behind the part of the 
 Tympanum which is elongated into the Eustachian Tube, 
 and its contiguity to the Cochlea, appear in this Figure. 
 
 a. The interior supeijices of the Tympanum. The line 
 which marks it is drawn from the elevation of the surface 
 that covers the apex of the Cochlea. 
 
 b. The Eustachian Tube slit open. 
 
 c. The Stapes. 
 
 d. The Tendon of the Musculus Stapedeus, issuing 
 through a little foramen in the bone. 
 
 c. The Fenestra Rotunda. 
 
 f. The Portio Dura of the Auditory Nerve. 
 
r 1 
 
 
 
 
 
 
 
 
 
 
PI. IV 
 
 
125 
 
 g. The Horizontal Canal. 
 
 ft. The Internal Carotid Artery. 
 
 Fig. V. 
 
 This Figure represents a portion of the interior Superfi- 
 cies of the Tympanum dissected to shew the Stapedeus Mus- 
 cle and the Canal of bone, which lodges the Tensor Mem- 
 brane Tympani. 
 
 a. The Musculus Stapedeus, dissected by opening the 
 bone which contains it. 
 
 b. The Stapes, receiving the Tendon of the Musculus 
 Stapedeus. 
 
 c. The Canal of the Tensor Membranae Tympani. 
 
 d. The little hole through which the tendon of the Ten- 
 sor Membranae Tympani is deflected. 
 
 Fig. VI. 
 
 This Figure represents the Skeleton of the interior super- 
 ficies Of the Tympanum (the Mastoidal Cells being in out- 
 line) that the Fenestra Ovata and Fenestra Rotunda may be 
 seen. 
 
 a. Fenestra Ovata. 
 
 b. Fenestra Rotunda. 
 
 PLATE IV. 
 
 Fig. I. 
 
 This Figure represents a dissection of that part of the 
 Labyrinth which forms the interior superficies of the Tym- 
 panum. The position of the central cavity, the Vestibule, 
 may be known by the Fenestra Ovata. The Cochlea is 
 placed before the Vestibule, with its apex inclined towards 
 
126 
 
 the Tympanum, and below the horizontal line. The two 
 turns and half of the Spiral Tube (the Spiral Lamina being- 
 removed) are shewn, and the communication of this Tube 
 with the Vestibule. A portion of the V ertical and Horizon- 
 tal semi-circular Canals are opened and traced, as far as 
 ' they can be seen in this view. 
 
 a. The Meatus Internus. 
 
 b. The Cochlea: the line is drawn from its apex; 
 
 c. The Vertical semi-circular Canal. 
 
 d. The Horizontal semi-circular Canal. 
 
 Fig. II. 
 
 This Figure represents a dissection of the Occipital side 
 of the Os Temporis, to shew the Meatus Internus; the Ob- 
 lique semi-circular canal, and the junction of its smaller ex- 
 tremity with that of the Vertical. 
 
 a. The Meatus Internus. 
 
 b. The Oblique Canal. 
 
 c. The Vertical Canal. 
 
 d. The common part of the two Canals. , 
 
 Fig. III. 
 
 This Figure is copied from Professor Scarpa. It is a 
 magnified view of the larger Membranous Sac of the Vesti- 
 bule, and the Membranous semi-circular Canals, and is in- 
 tended to illustrate the distribution of the Portio Mollis upon 
 them. 
 
 a. The Sac in which the semi-circular Canals and Scala 
 Vestibuli terminate. 
 
 b. The Vertical Canal. 
 
 c. The Oblique Canal. 
 
 d. The common termination of the Vertical and Oblique 
 Canals. 
 
 e.c. The Termination of the Horizontal Caral. 
 
427 
 
 f. The Portio Mollis. 
 
 g.g. The Portio Dura. 
 
 h. The Branch of the Portio Mollis supplying the Sac of 
 the semi-circular Canals. 
 
 i. The Branch of the Hemispherical Sac. 
 
 k. The Twig supplying the Ampulla of the Oblique Canal. 
 
 l. The Fasciculus of the Cochlea. 
 
 Fig. IV. 
 
 This Figure represents a dissection of the Cochlea, in 
 which the Scala Vestibuliis cut open through its whole ex- 
 tent, and the Cochlea is set upon its base, that the observer 
 may be able to judge ofits height. This dissection is design- 
 ed to shew the Spiral Lamina, with its Membrane, that 
 makes the Septum between the Scala Vestibuli and Scala 
 Tympani, which remains closed. 
 
 a.a.a. The turns of the Spiral Lamina, or Septum. 
 
 b. The Fenestra Ovata. 
 
 c. The Fenestra Rotunda. 
 
 d. The Apex of the Cochlea. 
 
 Fig. V. 
 
 This Figure represents a dissection of the Cochlea, in 
 which the Cochlea rests on its base, and one side of the Sca- 
 la V estibuli is opened. The section exhibits the appearance 
 of three compartments, and a portion of the Septum of the 
 Scala is seen in each. Its principal object is to shew the 
 little hole by which the two Scalae of the Cochlea communi- 
 cate. To understand this Figure, the reader must observe 
 that the Scala Tympani is not touched, that it begins under 
 the Septum, at the Fenestra Rotunda, makes parallel turns 
 with the Scala Vestibuli, and terminates at the common Fo- 
 ramen of the Apex. 
 
 a.a.a. The turns of the Spiral Septum. 
 
 b. The Fenestra Ovata. 
 
 c. The Fenestra Rotunda. 
 
128 
 
 d. The Hole of communication between the Scalse. 
 
 Fig. VI. 
 
 This Figure represents an oblique section of the Cochlea 
 on the side of the Meatus Internus. It lays open both the 
 Scalre, the portion of the Canal below the Spiral Lamina be- 
 ing the Scala Tympani, that above, the Scala Vestibuli. 
 
 1.2. 3.4. The edges of bone, made by the section of the 
 Spiral Tube: 1.2. the cut edges of the first turn — 2. 3. ditto 
 of the second turn: — 3 and 4. ditto of the third or half turn, 
 
 a. The first turn of the Spiral Lamina. 
 
 b. The second turn. 
 
 c. The third or half turn. 
 
 Fig. VII. 
 
 This Figure represents a dissection in which the Spirai 
 Lamina is left in connexion with the Modiolus and the Ves- 
 tibule, from which it derives its origin. The Fenestra Ova- 
 ta and the aperture of the Scala Vestibuli are laid into one, 
 by breaking down the partition between them. 
 
 a.a.a. The turns of the Spiral Lamina and the Modiolus. 
 
 b. The cavity of the Vestibule. 
 
 c. The hole of communication between the Seals. 
 
 Fig. VIII. 
 
 This is a magnified view of Fig. 7, to shew the Plexu3 ot 
 the Portio Mollis in the Spiral Lamina, on the side of the 
 Scala Vestibuli. 
 
 Fig. IX. 
 
 A magnified view of a similar section to that of Fig. 5, 
 with the exception, that the third turn cf the Spiral Tube is 
 -not opened. It is left closed, because the half tun. r the 
 Spiral Lamina is too minute to admit of the ne» - :s being 
 seen in this view. It is meant to shew the Plexus of the 
 Portio Mollis in the Spiral Lamina on the side of the Scala 
 Tympani. 
 
 FINIS. 
 

; ' 
 
 W: , 
 
 
 
 
 f 
 
 
 
 
 
 
 
 
 l ■ .