LIBRARY OF CONGRESS. 
 
 XT ^{^ 
 ®{j3p.^ ©op^rigip !f n. 
 
 Shelf..H..i:. 
 
 UNITED STATES OF AMERICA. 
 
PLATE 
 
 2. 
 
 5. 
 
 10. 
 
 u. 
 
 12 
 
 AVU, 
 
 UAVYUX/. 
 
DESCRIPTION OF PLATE I. 
 
 The color of the normal membrana tympani depends on the nature of the 
 light used for illumination, also upon its degrees of transparency. Hence it 
 may be represented from bluish white to bluish yellow. In Fig. i the bluish 
 predominates ; in Fig. 3 the yelloiv. If the membrane be decidedly transparent, 
 the manubrium of the malleus will be seen ; also the long shank of the incus, and 
 possibly the stapes, as in Fig. 4. The membrane is more opaque at the cetitre, 
 Figs. I, 2, 3, 4, also at the short process, shown at anterior superior portion, Figs. 
 I, 2, 3, 4; while at anterior inferior portion, Fig. i, we see the co7ie of light, the 
 changes of which are our guide in diagnosis. Fig. 3 shows slight congestion 
 of the manubrial vessels, which in Fig. 5 has extended to a general congestion. 
 Fig. 6 represents hemorrhagic spots, — ecchytnoses following in the order of 
 congestion. Fig. 7 is a sketch from a case of chronic supp7iration with vegeta- 
 tions, which disappeared, under caustic applications, leaving a perforation which 
 closed, at a later date. In chronic catarrh the membrane is often thin, trans- 
 parent, and retracted, the manubrium being very prominent. Fig. 10. In Fig. 
 II the yellow color suggests atrophy. Peripheral senile opacity, a parallel of 
 arcus senilis of the cornea, is shown by Fig. 12. 
 
PLATE 
 
 2. 
 
 10. 
 
 11. 
 
 12. 
 
 
DESCRIPTION OF PLATE II. 
 
 Fig. I. Vascular injection of superior portion of Mt., the lower portion re- 
 tracted, undefined, or attached to promontory. Fig. 2. Mt. largely destroyed, 
 the short process seen superiorly, crescentic folds extend on either side ; tissues 
 swollen, and marked by radiating vessels. In Fig. 3 the relations are less 
 clearly defined ; the displaced ossicula, incus, and stapes seen superiorly ; border 
 of membrane lost to view ; vessels radiate from the mucous membrane of the 
 promontor}-. Fig. 4. Appearances seen after chronic suppuration has ceased. 
 Mt. retracted and perforated; malleus out of line; covered by injected vessels ; 
 tissues darkened by interstitial deposits. Fig. 5. A similar condition ; the mal- 
 leus less displaced ; from its spatula end, deep folds of the membrane cause a 
 depression similar to a slit-like perforation. Fig. 6. Cicatricial Mt. ; in healing 
 the scar-tissue falls within the tympanum, causing irregular reflection from the 
 surface; the edges of the depression seem well defined; often vessels run over 
 the edges. Fig. 7. Ossicula displaced; malleus retracted; Mt. adherent to 
 stapes ; the continuity of Mt. restored by scar-tissue. Fig. 8. Mt. thickened by 
 long suppuration; pigmentary deposits and opacities. Autopsy showed ossicula 
 bedded in mucous membrane ; Mt. from upper edge to floor of t}-mpanum bound 
 to inner wall by a band of scar-tissue. Fig. 9. Calcareous deposits in Mt. 
 Crescentic posteriorly and inferiorly; also an irregular one seen anteriorly. 
 Patient had good hearing and a finely cultivated musical ear. Fig. 10. Cal- 
 careous opacities above and below ; also depressed cicatrix from end of malleus 
 to periphery. Fig. 11. Upper half of Mt. partiall)' ossified; lower part trans- 
 parent, probably a repair of old perforation, only the short process of malleus 
 visible. Fig. 12. Cicatricial tissue Mt. irregular; ossicula displaced, and 
 attached to posterior wall by cicatricial bands. 
 
LECTURES 
 
 CLINICAL OTOLOGY 
 
 DELIVERED BEFORE THE 
 
 SENIOR CLASS IN THE NEW-YORK HOMCEOPATHIC 
 MEDICAL COLLEGE, 
 
 TO WHICH ARE ADDED 
 
 CASES FROM PRACTICE, AND SUMMARIES OF REMEDIES. 
 
 BY 
 
 HENRY C. HOUGHTON, M.D., 
 
 SENIOR AITRAE SURGEON TO THE NEW-YORK OPHTHALMIC HOSPITAL, PROFESSOR OF OTOLOGY IN 
 
 THE COLLEGE OF THE NEW-YORK OPHTHALMIC HOSPITAL, PROFESSOR OF CLINICAL OTOLOGY 
 
 IN THE NEW-YORK HOMCEOPATHIC COLLEGE, FORMERLY PROFESSOR OF PHYSIOLOGY 
 
 IN THE NEW-YORK MEDICAL COLLEGE, AND HOSPITAL FOR WOMEN, FORMERLY 
 
 PROFESSOR OF PHYSIOLOGY IN THE NEW-YORK HOMCEOPATHIC MEDICAL 
 
 COLLEGE, MEMBER OF THE AMERICAN INSTITUTE OF HOMCEOPATHY, 
 
 FORMERLY PRESIDENT OF THE AMERICAN HOMCEOPATHIC 
 
 OPHTHALMOLOGICAL AND OTOLOGICAL SOCIETY. 
 
 
 BOSTON: 
 OTIS CLAPP AND SON, 
 
 3 BEACON STREET. 
 1885. 
 
A. 
 
 
 Copyright, 1885, 
 By OTIS CLAPP & SON. 
 
 ELECTROTYPED AND PRINTED 
 
 BY RAND, AVERY, AND COMPANY, 
 
 BOSTON, MASS. 
 
TO 
 
 D. B. ST. JOHN ROOSA, A.M., M.D., 
 
 PROFESSOR OF DISEASES OF THE EYE AND EAR IN THE UNIVERSITY 
 
 OF THE CITY OF NEW YORK, MY TEACHER THERE IN 
 
 OTHTHALMOLOGY AND OTOLOGY, ALSO MY 
 
 KIND ADVISER SINCE THEN; 
 
 TIMOTHY F. ALLEN, A.M., M.D., 
 
 PROFESSOR OF MATERIA MEDICA AND THERAPEUTICS IN THE NEW- 
 YORK HOMOEOPATHIC MEDICAL COLLEGE, MY TEACHER 
 AND EARLY GUIDE TO A SCIENTIFIC STUDY OF 
 REMEDIES FOR THE EYE AND EAR, 
 MY BELOVED FRIEND AND 
 COLLEAGUE, 
 
 5rf)is Wioxk is ©etiicatetr, 
 
 IN THE HOPE OF THE ABOLITION OF ALL DIVISION-WALLS 
 
 BETWEEN EDUCATED PHYSICIANS 
 
 AND SURGEONS. 
 
 HENRY C. HOUGHTON. 
 
PREFACE, 
 
 " Of making many books there is no end ; and much 
 study is a weariness of the flesh." Why add another book 
 to the hst ? Because it was solicited. Be assured it would 
 not have been added if not solicited. When the New-York 
 Ophthalmic Hospital was transferred to the service of a dif- 
 ferent surgical staff, the course of instruction that had been 
 established was continued. It devolved on me to give the 
 lectures on diseases of the ear, and a written petition from 
 one of the classes urged me to write a work which should 
 embody the results of experience obtained in the hospital 
 clinics. Such a work was underway in 1876, when serious, 
 and at one time apparently hopeless, illness prevented its 
 completion. In 1881 the manuscript was nearly complete, 
 when the announcement of " The Human Ear and its Dis- 
 eases," by W. H. Winslow, M.D., precluded, to my mind, the 
 issue of my work. 
 
 Since then, my duties as Professor of Clinical Otology in 
 the New-York Homoeopathic College have given another 
 occasion for a similar request for the substance, in book-form, 
 of the lectures given to the senior class. The manuscript 
 has been re-written from the notes of a stenographer ; and no 
 alterations have been made, except of errors in the structure 
 
VI PREFACE. ' . 
 
 of sentences, such as are liable to occur in extemporaneous 
 speaking. 
 
 The book is not written for the specialist, but for the stu- 
 dent and the busy practitioner, who will find in it sugges- 
 tions for the treatment of aural diseases, and indications for 
 remedies that have proved effective in a large clinical prac- 
 tice. At the request of some of my colleagues, there are 
 added cases from private practice, which illustrate the action 
 of certain remedies. 
 
 The repertory which is added to the lectures, is made from 
 material furnished by my friends Drs. Hering and Allen. 
 That it is my ideal, is not claimed ; that it may prove a step- 
 ping-stone to an ideal, may not be a vain hope. The win- 
 nowing of our materia medica may seem an easy task to the 
 young, enthusiastic student ; but, the longer one labors at 
 the task, the nearer he carries his sieves to the borders of 
 the Slough of Despond. Some material has accumulated 
 for a work similar to Allen and Norton's work in the field of 
 ophthalmic therapeutics ; but this work is even more difificult, 
 from the fact that aural pathology and diagnoses is a more 
 unsettled field of investigation. To such work, my mind has 
 been specially drawn ; audit is my purpose to preserve every 
 reliable result obtained. Crude, unreliable results are worse 
 than useless, serving as stumbling-blocks in our path. 
 
 To my colleagues, my effort is commended for their frater- 
 nal criticism, kind or caustic, only so it is true. If you find 
 confirmations, please report them to me ; if errors, note them 
 also, that we may have the truth. If any fellow-creature 
 shall be placed in better enjoyment of special function, and 
 thereby made happier and more useful, my hope will be 
 realized. 
 
 The chromo-lithographs are reproduced from the plates of 
 
PREFACE, Vll 
 
 Dr. Adam Politzer's " Monograph on the Membrana Tympa- 
 ni," issued by Messrs. WilUam Wood & Co. in 1869, to whom 
 I am indebted for permission to reproduce the same, as also 
 for the electrotypes furnished by them at the written request 
 of Professor D. B. St. John Roosa, M.D., from his work, "The 
 Diseases of the Ear." It gives me great pleasure to acknowl- 
 edge this courtesy of my esteemed instructor. 
 
 The cuts of instruments are furnished by Messrs. Meyro- 
 witz Bros, of this city. 
 
 New York, March 3, 1885. 
 
CONTENTS. 
 
 FIRST LECTURE. 
 
 PAGE 
 
 Introductory Remarks. — Motives which impel to Study. — Frequency of 
 Ear-diseases; their Serious Nature; Cause of Death; Reasons for 
 Apathy in the Past; no such Excuse now. — Advance in Aural Sur- 
 gery. — Pathological Research vs. Clinical Study. — Toynbee. — Con- 
 trast between Eye and Ear. — Instruments, and Methods of Use. — 
 Nomenclature 3-13 
 
 SECOND LECTURE. 
 
 Otitis Externa. — Circumscribed Inflammation: Symptoms; Cause; Treat- 
 ment; Remedies. — Diffuse Inflammation: Acute Form; Causes; 
 Symptoms; Tendency to Chronic Type; Treatment; Remedies. — 
 Eczema. — Haematoma, etc. — Otitis Externa Parasitica : Symptoms, 14-20 
 
 THIRD LECTURE. 
 
 Accumulation of Cerumen: Symptoms; Causes; Treatment. — Foreign 
 Bodies : Methods of Removal. — Lesions of Membrana Tympani. — 
 Fracture of Malleus. — Illustrative Cases. — Otitis Externa Circum- 
 scripta. — Otitis Externa Diffusa. — Ulcer in Meatus. — Chronic Der- 
 matitis. — Otitis Externa Circumscripta Acuta. — Otitis Externa Diffusa 
 Chronica. — Nsevus of the Auricle. — Erysipelas. — Otitis Externa 
 Diffusa Chronica. — Otitis Externa Parasitica: Three Cases. — Ef- 
 fects of Explosion. — Foreign Bodies in Meatus Auditorius Externus. 
 — Swn^nary of Remedies ........ 21-44 
 
 FOURTH LECTURE. 
 
 Acute Catarrhal Inflammation of the Middle Ear. — Classification of Dis- 
 eases of the Middle Ear. — Acute Catarrh a Frequent Disease : Symp- 
 
C0NTEN7S. 
 
 PAGE 
 
 toms ; Diagnosis ; Causes ; Prognosis ; Medicinal Treatment ; Instru- 
 mental Treatment. — Sub-acute Catarrhal Inflammation . . 47-52 
 
 FIFTH LECTURE. 
 
 Chronic Catarrhal Inflammation of the Middle Ear: History; Symptoms; 
 Subjective Symptoms of Catarrhal Form; Subjective Symptoms of 
 Post-catarrhal Form ; Objective Symptoms of Catarrhal Form ; Ob- 
 jective Symptoms of Post-catarrhal Form; Pathological Changes in 
 the Catarrhal Form; Pathological Changes in the Post-Catarrhal 
 Form ; Causes ; Treatment . .... . . . 53-59 
 
 SIXTH LECTURE. 
 
 Chronic Catarrhal Inflammation of the Middle Ear continued : Instru- 
 mental Treatment ; Injections ; Bougies ; Incision ; Politzer's Eyelet ; 
 Galvano-cautery Puncture; Myringodectomy ; Division of Tensor 
 Tympani ; Divisions of Adhesions; Traction with Siegel's Otoscope; 
 Medicinal Treatment 60-64 
 
 SEVENTH LECTURE. 
 
 Acute Suppurative Inflammation of the Middle Ear: Symptoms; Course; 
 
 Etiology ; Diagnosis ; Prognosis ; Treatment ; Remedies . . 65-70 
 
 EIGHTH LECTURE. 
 
 Chronic Suppurative Inflammation of the Middle Ear : Symptoms ; His- 
 tory; Prognosis; Treatment; Remedies . . . . . 71-79 
 
 NINTH LECTUREi 
 
 Consequences of Chronic Suppurative Inflammation of the Middle Ear : 
 Cicatrices and Adhesions; Polypi; Exostoses; Mastoid Disease; 
 Caries and Necrosis ; Cerebral Abscess ; Pyaemia ; Paralysis ; Opera- 
 tions and Remedies . '. . . . . . ... 80-87 
 
 TENTH LECTURE. 
 
 Unusual Diseases of the Middle Ear. — Spasm of Tympanic Muscles. 
 — Otitis Media Hemorrhagica. — Cancer. — Hairs in Tympanum. — 
 Exudation of Lymph. — Pulsating Tinnitus in Middle-ear Disease. — 
 Illustrative Cases: Otitis Media Catarrhalis Acuta; Otitis Media Ca- 
 tarrhalis Chronica; Otitis Media Suppurativa Acuta; Otitis Media 
 
CONTENTS. xi 
 
 PAGE 
 
 Suppurativa Chronica ; Application of Cotton Pellet ; Cicatrices ; 
 Polypi; Mastoid Disease. — Summary of Remedies . . . 88-153 
 
 ELEVENTH LECTURE. 
 
 Inflammation of the Internal Ear. — Meniere's Disease. — Otitis Interna 
 Exudativa Serosa. — Traumatic Disease. — Chejwpodhim Anthebniiiti- 
 cum 157-166 
 
 TWELFTH LECTURE. 
 
 Deaf-mutism : Helps to Hearing. — Illustrative Cases. — Summary of 
 Remedies 167-1J 
 
 APPENDIX. 
 
 List of Abbreviations 183-192 
 
 Repertory 193-252 
 
 Index 253-260 
 
LIST OF ILLUSTRATIONS. 
 
 PAGE 
 
 Mirror and Head-Band 6 
 
 Toyxbee's Speculum 6 
 
 Gruber's Speculum 6 
 
 ^Method of examining the Auditory Canal and Membrana 
 
 Tympani) 7 
 
 Eustachian Catheter 7 
 
 Introduction of Eustachian Catheter 8 
 
 Section showing Mouth of Eustachian Tube and Rosen- 
 
 MiJLLER's Fossa 8 
 
 Politzer's Apparatus 9 
 
 Method of using Politzer's Apparatus . . . . io 
 
 Siegel's Otoscope ii 
 
 TUNING-FORK 12 
 
 Aspergillus Nigricans i8 
 
 Aspergillus Flavescens i8 
 
 Pencillium Glaucum 19 
 
 Sexton's Forceps 19 
 
 Angular Forceps . 22 
 
 Buck's Probes and Paracentesis Knife 22 
 
 Ear-Syringe . 23 
 
 ]\Iethod of syringing the Ear 23 
 
 Fracture of the Malleus 27 
 
 Fracture of the ^Malleus replaced 27 
 
 Section of Head, showing ]\Iiddle Ear 55 
 
 Powder-Blower 74 
 
 Toynbee's Artificial Membrana Tympani . . . '75 
 
 xiii 
 
XIV LIST OF ILLUSTRATIONS, 
 
 PAGE 
 
 Blake's Wilde's Snare 8i 
 
 Heavy Knife for Mastoid Incisions 83 
 
 Buck's Drills 84 
 
 Diagram Mastoid Cells 85 
 
 Diagram to Illustrate Physiology of the Ear . . .158 
 Conversation-Tube . . . . . * . . . .168 
 Ear-Trumpet 169 
 
Part First. 
 
 DISEASES OF THE EXTERNAL EAR. 
 
FIRST LECTURE. 
 
 INTRODUCTION. 
 
 Gentlemen, — It gives me pleasure to meet you in this 
 place, not unfamiliar to me in my former relation as professor 
 of physiology in this college. My present position, however, 
 may be termed a new departure ; ajid it may not be unfitting 
 to refer to the providence which has led to this position. 
 
 At the close of the late war I came to this city, from my 
 home in Boston, Mass., with letters to the President of the 
 iVIedical Department of the University, and to Professor 
 A. C. Post, M.D. The latter gentleman received me kindly, 
 and, as his own clinical staff was full, gave me a letter of 
 introduction to Professor D. B. St. John Roosa, M.D., who 
 kindly invited me to a place on his staff as clinical assistant, 
 which position I held during two sessions. The acquaint- 
 ance thus begun has continued to this day. 
 
 Later, while physician to the " House of Industry," I was 
 favored with the advice and counsel of the late Carroll Dun- 
 ham, M.D., and Professor T. F. Allen, M.D. : to the latter 
 gentleman I am more especially indebted for initiation and 
 later guidance in the study and practice of the principles of 
 homoeopathy. In 1868 the " Xew-York Ophthalmic Hos- 
 pital " was placed in charge of a surgical staff, the members 
 of which were practitioners of homoeopathy. In December 
 of that year I received the appointment of aural surgeon. 
 During the first year the number of aural patients treated 
 was fifty-seven, I think ; and within seven years the number 
 rose to nearly one thousand. From the experience thus 
 
 3 
 
4 LECTURES ON CLINICAL OTOLOGY. 
 
 gained, I hope to be able to direct you to the methods of 
 instrumental and medicinal treatment which in my practice 
 have been proved efficient. It is my purpose in these lec- 
 tures, to present to you, in connection with such clinical ma- 
 terial as shall offer, the general features of diseases of the 
 ear ; and I shall endeavor to present them in a way so prac- 
 tical that the suggestions which you receive, may prove of 
 value in your hours of need as busy practitioners. 
 
 The motives which impel one to study are usually mixed ; 
 and, while the greater should always be a desire to benefit 
 one's kind, the secondary one, of personal benefit, is not un- 
 worthy of notice. 
 
 You will find in experience, that knowledge and skill in 
 the treatment of special diseases will bring legitimate prac- 
 tice in other directions Certain facts may induce you to 
 give more careful attention to these diseases, and impress 
 you with their importance. We have to consider their fre- 
 quency, their serious nature, their effect upon life and use- 
 fulness, also their agency as a direct cause of death, their 
 anatomical relations, giving rise to cerebral disease. 
 
 First, As regards their frequency. In 1856 Kramer re- 
 ported, that, in Prussia, statistics showed one deaf-mute in 
 1,109, and one blind person in 1,730. If we add to the deaf- 
 mutes the number of those patients affected with other ear- 
 diseases, we shall see that the difference between the two is 
 even greater. 
 
 Notice, secondly, the serious nature of these diseases in 
 their effect upon human life, determining, not only its limit, 
 but its usefulness. The child that loses his hearing before 
 seven years of age, may become a deaf-mute ; and, if not a 
 deaf-mute, the limitation put upon this avenue to the brain 
 dwarfs his whole mental development. Then, too, the child 
 that has suppurative disease is often the object of aversion, 
 becomes morose, m.isunderstands others, is misunderstood in 
 turn, and grows up under this acquired antagonism to his 
 fellows. 
 
 It is now known that the causes of death in many cases 
 
nVTK OD UC TWX. 5 
 
 hitherto mysterious, are not lesions of the heart or of the 
 spinal cord, but of the brain, and result directly from ab- 
 scesses, which are secondary to disease of the ear. Notice 
 now the anatomical relations. Above, the cerebrum, sepa- 
 rated only by a thin plate of bone ; below, the maxillary 
 articulation, jugular veins, carotid artery, and numerous 
 nerves ; posteriorly, the mastoid cells in immediate relation 
 with the cerebellum. Suppuration occurring here may cause 
 mischief in either of these directions. In fact, in the child, 
 before the temporal bone is fully formed, the relation is 
 direct to the cerebrum ; while, in the adult, it is more direct 
 to the cerebellum. It is a fact that no branch of sursfical 
 practice has so failed from lack of general interest as aural 
 surgery. The reason is found in the apathy of the profes- 
 sion toward it, which has been due, undoubtedly, to the 
 earlier fact that this branch of practice was in the hands of 
 charlatans ; relegated even to barbers. To-day there is no 
 reason for lack of interest : no department of medical or sur- 
 gical study has shown such advance as aural surgery during 
 the last quarter of a century. This advance is due to patho- 
 logical, as well as to clinical, study. First to provoke an in- 
 terest in pathological research is to be named Toynbee, the 
 English aurist, who has left behind him, in *' Hunter's ]\Iu- 
 seum of the College of Surgeons," London, a collection of 
 morbid specimens which is a monument to his patience and 
 skill. In later years, English, Continental, and American 
 surgeons have added their quota to the store of knowledge. 
 
 This has been supplemented by clinical study, both abroad 
 and in this country, to such an extent that we are left with- 
 out excuse for any neglect in the care of this class of patients. 
 
 Turning, now, to the subject which shall engage us, I ask 
 you to notice the contrast between the eye and ear as re- 
 gards clinical instruction. Very many diseases of the eye 
 can be studied without instrumental examination ; but, in 
 the study of the diseases of the ear, in almost all cases the 
 use of instruments is required. 
 
 As regards the instruments, I shall simply call your atten- 
 
6 LECTURES ON CLINICAL OTOLOGY. 
 
 tion, at present, to those more easily employed. To the use 
 of the aural mirror is due most of the advance made in clin- 
 ical otology. It was invented by Von Troltsch immediately 
 
 Mirror and Head-Band. 
 
 after the introduction of the ophthalmoscope, and involves 
 the same principles, modified for its special uses. Previously 
 
 OOo 
 
 Ooo 
 
 Toynbee's Speculum. 
 
 Gruber's Speculum. 
 
 to the introduction of this instrument, the surgeon depended 
 upon direct illumination, which was almost futile on account 
 
INTRODUCTION. 7 
 
 of the narrowness and depth of the auditory canal It now 
 supersedes every other means of ilkimination. In connec- 
 tion with this instrument we have the aural speculum, modi- 
 fied according to the ideas of different teachers. The one 
 which I use, and prefer, is Toynbee's, which, having an 
 
 Method of examining External Auditory Canal, (Roosa.) 
 
 oval opening, can be adapted to the long diameter of the au- 
 ditory canal, giving us a more complete view of the mem- 
 brana tympani. 
 
 The Eustachian catheter, Politzer's apparatus for inflation, 
 and Siegel's pneumatic otoscope, are here shown you. The 
 method of their use will be demonstrated in connection with 
 cases, but I will say a few words as to their application in 
 diagnosis as well as treatment. The first is of special value 
 in cases in which only one ear is affected, as inflation by 
 those methods that 
 affect both ears may 
 act unfavorably on the 
 
 healthy ear. With the '®"^^ eustachian Catheter. 
 
 catheter the air can be 
 
 forced directly into the middle ear ; but its use is open to the 
 objection, that it causes irritation of the mucous membrane 
 of the nares, and mouth of the Eustachian tube, and in care- 
 
LECTURES ON CLINICAL OTOLOGY. 
 
 Introduction of Eustachian Catheter. (Roosa.) 
 
 Section showing Mouth of Eustachian Tube. (Roosa.) 
 
IXTRODUCTIOX. 9 
 
 less hands has done mischief ; but it is not exceptional in that 
 respect. The introduction of the catheter is an easy matter 
 in most cases. Dexterity comes by practice. Hold the in- 
 strument free in the fingers, not stifitly, thus : introduce the 
 beak while the instrument is almost perpendicular ; raise 
 slowly to the horizontal, pass slowly back, withdraw slightly 
 if you meet obstruction ; turn a little to one side, pass back 
 till the beak is free in the posterior nares, press back till 
 the instrument is stopped by the posterior wall, then draw 
 slightly forward, turning the ring of the instrument toward 
 the ear affected. If the beak drop into the ostium of the 
 Eustachian tube, it will not move during the act of degluti- 
 tion ; if it do so, it must rest on the lateral wall ; turn the 
 
 Politzer's Atparatus. 
 
 ring to its first position, and repeat the manipulation ; a little 
 patience, and it will come to its place ; now use the air- 
 balloon, and the air is felt in the middle ear. 
 
 Politzer's method of inflation consists in the use of the air- 
 bag, with a flexible tube, having a suitable nose-tip, which is 
 introduced in the nostril, the opposite one being closed by 
 the fingers while holding the nose-tip in position : the pa- 
 tient is directed to blow as in putting out a light, or pro- 
 nounce hock ; and at that moment the air is forced from the 
 
10 
 
 LECTURES ON CLINICAL OTOLOGY. 
 
 air-bag by sudden closure of the hand. The pharynx being 
 divided, by the action of the soft palate, into superior and 
 inferior portions, the openings of the superior portion are 
 the Eustachian tubes and the nasal passages. Now, if the 
 latter are closed, and air be forced through the nose-tip as 
 above, the air must pass into the tympanum. If whistling 
 or articulation fail to cause strong action of the pharyngeal 
 
 Method of using Politzfr's Apparatus. (Roosa.) 
 
 muscles, direct the patient to hold a little water in the mouth, 
 and, upon commanding him to swallow, force the air from 
 the air-bag as the water passes from the mouth. If this fail, 
 use the catheter, or give the remedy best indicated in the 
 case, and wait its action for a few days, till the condition of 
 the mucous membranes is changed ; then inflation will be ac- 
 complished more readily ; indeed, in many cases, the remedy 
 causes the tube to open spontaneously. This method is free 
 
INTR on UC TION. 1 1 
 
 from the objection urged against the catheter, but is open 
 to another : frequent and forcible use causes distention of 
 the parts, and injury has resulted from trusting the instru- 
 ment to lay hands. The same may be said of Valsalva's 
 method, or rather experiment as it is called. This is per- 
 formed by closing the nares with the fingers, and attempting 
 to blow through the nose. This method of inflation should 
 never be used as a m.eans of treatment, and patients should 
 be informed of the bad results which follow its practice. 
 We often see relaxed and flaccid membrana in the persons 
 of those who have learned to " blow out the ears." 
 
 Siegel's otoscope is very valuable for settling various 
 points on differential diagnosis, — such as conditions of the 
 external layer of the drum-membrane, perforations in the 
 
 Siegel's Otoscope. 
 
 same, adhesions in the tympanum, etc. It is also applicable 
 as a means of producing passive motion in the articulations, 
 and, possibly, of breaking adhesions between the membrana 
 tympani and the ossicula or the labyrinthine wall. By intro- 
 ducing the speculum firmly in the meatus, and alternately 
 forcing the air in, or exhausting it, the movements of the 
 drum-head may be studied under strong light. 
 
 The stop-watch ^ is of great value in testing the hearing- 
 distance ; as by it you are able to exclude any illusions on the 
 
 ^ The Auburndale timer, sold by Cross & Beguelin, No. 21 Maiden Lane, New York, is 
 well adapted to the purpose, and is not expensive. There is also a similar timer, made 
 in Switzerland, which can be bought in this city at less price. 
 
12 
 
 LECTURES ON CLINICAL OTOLOGY. 
 
 part of the patient, by alternately starting and stopping its 
 action. The distance at which the watch is heard should be 
 recorded in fractional form, as suggested by Dr. Prout of 
 Brooklyn, and modified by Drs. Knapp and Roosa. H, rep- 
 resents the watch ; V, spoken voice ; v, whispered voice. 
 Hence, H 20-20 means normal hearing ; 10-20, a watch heard 
 by person with normal hearing 20 feet, is heard only 10 feet. 
 If heard only i inch, the expression is 1-20X 12=1-240. The 
 record for spoken voice thus : V 60-60 ; that is, the normal 
 hearing is 60 feet ; then, by 10-60, we understand the voice is 
 heard by the deaf person, under examination, only 10 feet. 
 
 The Tuning-Fork. 
 
 The tuning-fork is used to determine the state of the 
 acoustic nerve, or to differentiate between lesion of the in- 
 ternal and middle ear. In the normal ear, the tuning-fork, 
 vibrating before the ear, is heard better through the air than 
 when placed on the bones of the skull. In disease, if the 
 fork is heard better through the air than when placed on the 
 skull, it is evidence that the acoustic nerve is affected : but, 
 if the fork is heard better on the bones, it indicates disease 
 of the middle ear, or external auditory canal, or both ; be- 
 cause rigidity of the ossicula, or obstruction of the meatus, 
 causes increased and prolonged vibration of the auditory 
 nerve. 
 
INTRO D UC TION. 1 3 
 
 Care should be taken to make complete and full record of 
 each case at the first, and on each subsequent, visit. By 
 comparing these records, you are better able to judge of 
 results ; and they will prove invaluable to you as matters 
 of history and statistics. 
 
 In the course of these lectures, I shall endeavor to follow, 
 as closely as possible, the classification and nomenclature 
 which I shall give you ; but it will be necessary to deviate 
 from them, for material offered at the clinic is not always 
 classified to our hand. 
 
 Diseases of the ear are divided according to their anatom- 
 ical basis, — otitis externa, media interna. Otitis externa 
 embraces all the diseases of the auricle, lesions of the der- 
 moid structure, of cartilage, and of the external surface of 
 the membrana tympani. Under these may be named, dif- 
 fuse inflammation, either acute or chronic ; circumscribed 
 inflammation, always acute ; myringitis, ulcerations, necrosis, 
 polypoid growths, parasitic diseases, exostosis. 
 
 Note. — In using Politzer's method of inflation, I have recently found, that 
 directing the patient to blow through a small glass pipette gives better results 
 than either of the methods formerly used. The patient is directed to hold the 
 tube in the hand opposite the side to be treated ; place it in the corner of 
 the mouth ; take a full inspiration, and blow with great force ; at the moment 
 of greatest effort, use the air-bag as usual. 
 
SECOND LECTURE. 
 
 CIRCUMSCRIBED INFLAMMATION AND DIFFUSE INFLAMMATION. 
 
 Gentlemen, — Otitis externa^ or inflammation of the ex- 
 ternal ear, is divided into circumscribed and diffuse. 
 
 Otitis externa ciratniscripta (peri-follicular inflammation) is 
 inflammation of the dermoid elements and connective tissue 
 of the external third of the auditory canal, commonly known 
 as furuncle. 
 
 Symptoms. — The earliest symptoms consist of an itching 
 or burning sensation, which later increases to actual pain. 
 This pain is not usually severe, unless the tissues beyond 
 the outer third are involved. If this be so, as is the case 
 when the patient is suffering from a severe series of furun- 
 cles, the pain is agonizing, associated with great constitu- 
 tional disturbance, and in some cases with delirium. The 
 ordinary experience, however, is possibly twenty-four hours of 
 suffering, followed by a lymphy or purulent discharge from 
 the meatus ; and the disturbance is passed for the time. The 
 objective symptoms are swelling, redness, and, on touching 
 with the probe at some circumscribed spot, the patient will 
 shrink on account of the pain. The history of the trouble 
 is usually short, the resolution prompt. After a few days 
 the dermoid structures are exfoliated, and the meatus as- 
 sumes its normal appearance. 
 
 Cause. — The cause is usually to be found in the direction 
 
 of excess, or in lack of proper diet, or some wrong habit 
 
 which modifies nutrition ; so that we may say, furuncle is 
 
 the rich man's penalty or the poor man's necessity. The 
 
 14 
 
CIRCUMSCRIBED AND DIFFUSE IiYFIAMMATION. 1$ 
 
 fact that furuncles occur either in spring or fall may suggest 
 a constitutional change incident to the season. Such symp- 
 toms demand attention. 
 
 Treatment. — The treatment consists in the local applica- 
 tion of some remedy to mitigate the pain, and the administra- 
 tion of such remedies as will overcome the habit. Plaiitago 
 major, fluid extract, and warm water in equal parts, dropped 
 into the meatus as warm as can be tolerated, or applied on 
 absorbent cotton, or a few drops of Magendie's solution 
 applied in the same way, will ameliorate the pain, and will 
 not interfere with the action of internal remedies. Among 
 the various remedies that have been used are belladonna^ 
 Pulsatilla, hepar snlpJi., and mercnrins. 
 
 As regards the incision of furuncle, I am satisfied that it 
 is better practice not to cut deeply, to abort, or to evacuate, 
 the abscess, but to allow it to take its course ; as the worst 
 cases of repeated inflammation that have come under my 
 observation have been those in which incisions were made. 
 Soon after the proving of picric acid, my attention was called 
 to that remedy by Dr. Clara C. Plympton, a graduate of the 
 Ophthalmic Hospital ; and since that time the remedy has 
 been used for that disease, and may be considered as nearly 
 a specific for it as is any remedy for any disease. Last 
 spring I had occasion to prescribe picric acid in the case of 
 a young lady, twenty-five years of age, who had suffered from 
 a series of furuncles in the meatus, which bade fair to reach 
 the mystic number seven, — this being the limit which in 
 the lay mind is supposed to exist. Picric acid relieved the 
 symptoms, but Jiepar siilph, calc. was necessary to complete 
 the cure. A relapse and the necessity for a repetition of the 
 picric acid suggested to me a combination of these two 
 drugs. I therefore obtained through Messrs. Boericke & 
 Tafel the compound salt : it is called calcarea picrata, and it 
 has been used in a number of cases in the hospital during 
 this session. It bids fair to warrant the late Dr. Hering's 
 statement, that the combination of two remedies in a com- 
 pound gives the curative action of each in a greater degree. 
 
1 6 LECTURES ON CLINICAL OTOLOGY. 
 
 Otitis externa diffusa may be divided into two forms, acute 
 and chronic. 
 
 Cause. — The acute form usually results from some exter- 
 nal irritation of the tissues of the meatus, arising from the 
 use of some instrument in picking, scratching, or digging 
 into the meatus, as is the habit of many persons. 
 
 Symptoms. — The symptoms are itching, burning, with a 
 sensation of obstruction in the meatus, and a greater or less 
 degree of loss of hearing. The chief objective symptoms 
 are closure of the meatus, and the oozing of lymphy or puru- 
 lent fluid. On touch with the probe, pain is caused in all 
 parts of the meatus, in contrast to otitis externa circumscriptay 
 in which pain is caused only on touch of the furuncle. The 
 course of the disease is less rapid than the circumscribed 
 form, often lasting a number of days or weeks, and tends to 
 a chronic type. If its course be limited, and resolution be 
 prompt, the dermoid structure of the meatus will be exfoli- 
 ated, and, in many cases, can be removed almost entire : on 
 removal, the outer third of the canal will be left denuded, 
 red and shining. This process of exfoliation will be repeated 
 until the integument assumes its normal condition. 
 
 Treatment. — The suggestion previously made regarding 
 the use of some remedy to mitigate the pain, holds good in 
 this form of the disease. You will understand, therefore, 
 that I am not an extremist in the administration of internal 
 remedies, but believe that the mitigation of symptoms by 
 local application is judicious practice, assured as I am that it 
 does not interfere with the action of internal remedies given. 
 
 The remedies for the acute stage are, aconite in a few in- 
 stances ; more usually belladonnayferricmphos.yheparsulph.y 
 viercztriiis, kali miir., and Pulsatilla. The differential diag- 
 nosis between aconite and belladonna will be clear to your 
 minds at the sight of the extreme restlessness, flushed face, 
 and great thirst of aconite patient. The choice between 
 hepar sidpJi. and mercnrins is, that the hepar is indicated 
 in extreme sensitiveness to the air, — which is relieved by 
 wrapping, — aggravation at night. Sensitiveness to touch is 
 
CIRCUMSCRIBED AND DIFFUSE INFLAMMATION I J 
 
 more localized than in mercurius. In the latter remedy, 
 the nightly aggravation is more marked than hepar sulph., the 
 sensitiveness to air is less, the soreness more generally 
 about the ear. Pulsatilla is more frequently indicated in 
 circumscribed inflammation, but in women and children its 
 characteristic symptoms will sometimes occur. Chamomilla 
 will be indicated in some few cases by the extreme tolerance 
 of pain. 
 
 Instrumental treatment is more likely to be required than 
 in the circumscribed form ; as it will be necessary to remove 
 all portions of exfoliated epithelial structures from the canal, 
 lest they become the nidus of plugs of detritus, of cerumen, 
 etc. The application of fluid petroleum with a camel's-hair 
 brush will relieve the intense irritation and itching which 
 mark the process of resolution. 
 
 Associated with this strictly technical division of our sub- 
 ject is the matter of foreign bodies, mal-secretion of cerumen, 
 skin-diseases of the auricle, and region above the ear, para- 
 sitic growths, as well as animal parasites. 
 
 Eczema of the auricle, or the region immediately about it, 
 is the same here as in other parts of the body ; and there is 
 nothing special to say in regard to its treatment other than 
 that aj'senic, grapJiites^ mezeretmii and stdpJnir are the reme- 
 dies most frequently indicated. The deep cracks which form 
 behind and below the auricle, yield to graphites ; and we have 
 found the cure to be hastened by the local application of 
 graphites combined with concentrated petroleum, which has 
 been largely used in similar forms of mflammation of the 
 eyelids, 
 
 Psoriimm is an invaluable remedy, often superior to sulphur 
 in cases in which the latter remedy has been formerly used. 
 
 The following symptoms, as given by Hermg, we have con- 
 firmed again and again. External ears, raw, red oozing ; 
 scabs form ; sore pain behind the ears. Otorrhoea very 
 offensive, purulent ; watery, stinking diarrhoea. Pustules 
 on and behind concha. Scabby eczema behind right ear. 
 Herpes from temples over ears to cheeks at times throws off 
 
i8 
 
 LECTURES ON CLINICAL OTOLOGY. 
 
 innumerable scales ; at other times, painful rhagades with 
 yellow discharge, forming scurfs, fetid humor ; itching intol- 
 erable. 
 
 Aspergillus Nigricans, 220 Diameters. (Roosa.) 
 
 a. Mycelium fibre, h. Fruit-bearing fibre, c. Naked sporangium, d. Sporangium covered with 
 basidia only. e. More mature sporangium, i. Spores in a state of germination. 
 
 Aspergillus Flavescens, 220 Diameters. (Roosa.) 
 
 a. Mycelium fibre. b. Fruit-bearing fibre. c. Sporangium-bearing spores upon the basidia 
 g. Basidia showing construction preparatory to the separation of spores, k. Epithelium. 
 
 Haematoma is most satisfactorily treated by evacuation of 
 the contents of the sac, and application afterwards of press- 
 ure. In a few cases, the galvanic cautery has proved efH- 
 
CIRCUMSCRIBED AND DIFFUSE INFLAMMATION. 
 
 19 
 
 Pencillium Glaucum. (Roosa.) 
 
 cient in forming clot, and possibly hastening the resolution 
 after the evacuation and pressure. 
 
 Malformation of the auricle or of the lobule, or abscess, 
 and cutting of the ring-hole and lobule by heavy earrings, 
 
 are the subjects of plastic opera- 
 tions, which belong as much to the 
 sphere of general plastic surgery as 
 to aural surgery. 
 
 Otitis externa parasitiea is caused 
 by the presence and production of 
 microscopic vegetable parasites. 
 The most usual form is that of as- 
 pergillus glaucus, which is interchangeable w4th pencillium 
 glaucum. There was a difference of opinion concerning the 
 production of this parasitic growth, — some claiming that a 
 spore being deposited in the canal caused the inflammatory 
 action, and flow of lymphy pus ; others, that a previous ero- 
 sion, abrasion, or macera- 
 tion of the tissue gave the 
 necessary moisture which 
 facilitated the growth of 
 the* fungus. The latter 
 view now prevails. The 
 growth consists of myce- 
 lium, which forms the bed, 
 or mass, of the growth, 
 from which rise the small 
 trunks : on the tops of 
 these trunks are produced 
 the bundles of spores, 
 which, when ripe, are shed 
 beneath, forming new cen- 
 tres of growth. In this 
 
 way the mass is reproduced until it covers the entire walls, 
 layer upon layer on the surface, and the whole canal is oc- 
 cluded. 
 
 Symptoms, — The symptoms are obstruction, with a low 
 
 Sexton's Forceps. 
 
20 LECTURES ON CLINICAL OTOLOGY, 
 
 degree of pain when the occlusion of the meatus becomes 
 complete ; and, in extreme cases, pressure upon the canal will 
 cause very severe reflex symptoms in the head, even as far 
 as the neck and arm. The chief symptoms are similar to 
 those caused by a plug of cerumen, with this difference, how- 
 ever, that ordinarily the cerumen will be removed without 
 difficulty, and without causing any abrasion of the walls of 
 the canal : the parasitic growth forms a dense mass, which 
 one is unable to remove except by tearing it piecemeal from 
 the walls, leaving them abraded, and oozing bloody lymph. 
 The whole canal will be left in this condition, and thus form 
 a very favorable field for the reproduction of this growth, 
 unless some agent is used to destroy these microscopic 
 organisms. 
 
 Note. — I have utilized the Eustachian catheter and the ear-syringe together 
 in a way that I have not seen advised by another. Instrument-dealers make the 
 syringe with a blunt tip and a posterior-nares tip. These are interchangeable. 
 Messrs. Meyrowitz Bros, have added to these, three Eustachian catheters. The 
 advantage gained by the latter is in the fact, that the surgeon can get an unob- 
 structed view of the meatus, as the hand is turned to the side, right or left, above 
 or below, while he directs the stream of water in any direction. Another advan- 
 tage gained is this, that the catheter does not interfere with the outward flow of 
 the water, and cause awkward spills. 
 
THIRD LECTURE. 
 
 ACCUMULATION OF CERUMEN. REMOVAL OF FOREIGN 
 
 BODIES. 
 
 Gentlemen, — We will take first to-day as the subject of 
 our consideration, the AcciLmidation of Cerumen. There is 
 no reason why the glands of the skin of this locality should 
 not be subject to deviation from normal action ; and we find 
 deviations in both directions, excessive action as well as lack 
 of proper secretion. 
 
 The symptoms of impacted cerumen are, sudden loss of 
 hearing, tinnitus aurium, vertigo, sense of fulness. A mass 
 of soft cerumen with the slightest chink between it and the 
 wall of the meatus will cause no trouble ; but when under any 
 circumstances it is dislodged, the mass will produce at once 
 the foregoing symptoms. Von Troltsch mentions the case 
 of an old man, who, on his way home after a wine-supper, fell 
 over the pole of a wagon. For fifteen minutes he was appar- 
 ently senseless, but recovered sufficiently to reach home. 
 The next morning his physician diagnosed the case as con- 
 cussion, or possibly apoplexy, due to the fall, or blow on the 
 head from striking the pavement. The patient, who was 
 otherwise well, was dieted, cupped, purged, and, after a few 
 days, a seton was introduced into the back of his neck. A 
 month later Von Troltsch was called, and found both canals 
 stopped with cerumen. He was immediately relieved of 
 deafness, and of the ** profound cloudiness of intellect" fol- 
 lowing concussion of the brain. Roosa mentions a similar 
 case, which was attributed to sunstroke. 
 
22 
 
 LECTURES ON CLINICAL OTOLOGY. 
 
 Causes. — As has been intimated, the accumulation is due 
 to the excessive action of the sudoriferous and ceruminous 
 glands ; the immediate cause being efforts at cleanliness, or 
 manipulation with various instruments, to relieve the ear 
 
 from symptoms that are 
 caused by conditions of the 
 middle ear. 
 
 Treatment. — In all cases, 
 examine the ear with reflect- 
 ed light. When the canal 
 is well illuminated, move the 
 mass, if possible, so as to 
 form a passage on either side along the wall of the canal. 
 The best instrument for this is Buck's loop-probe, or curette. 
 Then with a syringe direct a stream of water into the pas- 
 sage, or chink, which has been made between the mass and 
 the wall of the canal. In this way, you will often dislodge 
 the entire mass by one or two efforts. In some cases, you 
 will be unable to remove the mass at the first sitting without 
 causing more irritation than is safe. In such a case, direct 
 the patient to instil into the meatus every night five drops of 
 fluid petivleinn, or of a mixture of three arachms of petroleum 
 
 Angular Forceps. 
 
 MEYROWITZ BROS.^ 
 
 Lance-shaped Perforator. 
 
 WEYR0WIT2BRCS> 
 
 Buck's Probes. 
 
 Paracentesis Knife 
 
 and one drachm of stdplniric ether. The effect of either of 
 these is to concentrate the mass, to separate it from the 
 walls ; and you are often able to remove easily the entire 
 mass with forceps after a few days. 
 
ACCUMULATION OF CERUMEN. 
 
 23 
 
 A peculiar condition is sometimes noticed, in which the 
 cerumen, besides forming in thin scales along the walls of 
 the meatus, covers the membrana tympani with similar scales, 
 and interferes decidedly with the function of hearing. The 
 instilled petroleum will separate such scales, which can 
 easily be removed with cotton upon the end of a proper 
 holder. 
 
 Method of syringing the Ear. CRoosa.) 
 
 In some cases, there is noticed a condition called keratosis 
 obdurans. Opinions differ as to the nature and formation of 
 this mass ; but I believe that the weight of authority is in 
 favor of the view, that it is simply a mass of cerumen and 
 scales, which has become impacted by slow accumulation 
 and long exposure till it has become hornlike. In such cases, 
 the mass is not usually removed entire, but is first broken 
 into small pieces by the probe, and then removed by forceps. 
 
24 LECTURES ON CLINICAL OTOLOGY. 
 
 The conditions which exist after the removal of these 
 masses often require attention. The pressure of the mass 
 may give rise to circumscribed ulcerations : these being neg- 
 lected would become the foundation of future similar troubles. 
 I would suggest pencilling the canal with petroleum com- 
 bined with calendula, and occasional inspection until the 
 normal condition is observed. Be careful always to test 
 the hearing after the removal of foreign bodies, so that, in 
 the great relief which follows the removal, you may not neg- 
 lect the diagnosis of an existing middle-ear disease. 
 
 Foreign bodies. — At the close of my last lecture, I found 
 a little patient whose case would have illustrated the method 
 of removing small foreign bodies from the external meatus. 
 The child, while playing with some grain, had put several 
 kernels in the ears. A day or two later, the parents learned 
 this fact, as the grain caused some annoyance ; attempts at 
 removal only aggravated the mischief : and the child resisted 
 examination, fearing more suffering. Illumination of the 
 canal without the speculum showed the end of one kernel, 
 and one discharge of the syringe filled with warm water re- 
 moved all the grain. This is the simplest method of proced- 
 ure when examination shows that the stream of water will 
 pass between the walls of the external meatus and any for- 
 eign body, such as bits of cork, pebbles, beads, etc., — in fact, 
 any thing that the " awful boy " may feel disposed to place 
 within his meatus. The same suggestions touching the 
 removal of hard masses of cerumen hold good in these cases ; 
 and your own surgical skill, enforced by clever wit, will help 
 you out in many instances by peculiar devices. In a case 
 mentioned to me by the late Dr. Carroll Dunham, a lad 
 plugged his ear with a cork from a vial, completely occluding 
 the meatus. Dr. Dunham used a dental excavator ; and, by 
 patiently excavating a triangular cavity with its base inward, 
 he was able to pass an explorer into the cavity, securing its 
 point in the side, and drew the cork from the ear. Lowen- 
 berg mentions the application of a camel's-hair pencil, satu- 
 rated with glue, to the surface of an ivory ball, leaving it 
 
FOREIGN BODIES, 2$ 
 
 until it adhered perfectly, then withdrawing pencil and ball 
 at one effort. A writer suggests the use of loops of horse- 
 hair, three or four hairs gathered together, both ends in the 
 fingers, pushed into the ear as far as the drum-head, then 
 twisted in the fingers, to remove a small foreign body. An- 
 other suggests the expedient of turning the ear involved 
 towards the floor, as the patient lies on the table ; then, as 
 the head projects beyond the table, syringe from below, 
 upward, and the weight of the body will aid in its fall from 
 the ear. I have succeeded in removing a number of foreign 
 bodies, which have by previous manipulation become im- 
 pacted, by using a probe bent at right angles, similar to a 
 tenaculum, pushing it between the body and the wall while 
 the patient was under ether. Having passed the foreign 
 body, turn the tenaculum at right angles to the wall, and, on 
 withdrawing the instrument, the foreign body must necessa- 
 rily come with it. Animate foreign bodies, as flies, bed-bugs, 
 croton-bugs, have all been subjects of our attention at the 
 clinic. In two cases the cimex had entered in an animate 
 state, and yielded in one case to warm oil, and, in the other 
 case, to a dose of brandy and water ; the sufferer being a 
 denizen of the region of the "Five Points," this remedy was 
 probably a panacea for all his troubles. The simplest method 
 is to instil warm water or warm oil ; and, later, the surgeon 
 can easily remove the insect by the use of the syringe. 
 
 Writers mention cases in which insects have found in the 
 secretion of the ear a favorable nest for their eggs, and, later, 
 larvae in large quantities have developed, l^he use of warm 
 water with a few drops of carbolic acid, or an alcoholic solu- 
 tion of boracic acid, will dispose of the whole matter. 
 
 The laity, and even some members of the profession, have 
 the idea that a foreign body in the meatus is a matter of 
 great danger. It is not so. The immediate danger is less 
 grave than dangerous interference : hence be sure you see 
 the body before you attempt its removal. Harsh attempts 
 at removal cause impaction. Serious consequences have 
 followed ill-advised attempts at removal. One standard au- 
 
26 LECTURES ON CLINICAL OTOLOGY. 
 
 thority reports death as the result of efforts, with probes 
 and forceps, to remove a nail which was supposed to have 
 lodged in the meatus ; and after the removal of several small 
 bones, shreds of membrane, etc., the patient was left in col- 
 lapse, on the supposition that the nail had passed into the 
 cerebral cavity. The post-mortem demonstrated the absence 
 of any foreign body. 
 
 The presence of a foreign body in the meatus will give rise 
 to peculiar and seemingly grave symptoms in some cases. 
 Some time ago a member of the fire-department called at 
 the clinic, saying he had let water in his ear while bathing 
 his head at the hydrant. The full stream had struck him on 
 the head. Soon after, an irritation of the ear, neck, and 
 shoulder had set in, alarming the patient, who feared paraly- 
 sis would result. On examination, a white mass was seen at 
 the lower inner extremity of the canal, resting against the 
 drum-head. Syringing with warm water brought away a 
 quartz pebble, and all irritation of the nerves on that side of 
 the body ceased at unce. 
 
 We come now to consider some lesions of the membrana 
 tympani. This structure is so important in relation to the 
 objective symptoms, that more than a passing notice is de- 
 manded. From its relation to the external as well as the 
 middle ear, it partakes of the nature of both, and is subject 
 to changes having their beginnings either in the meatus 
 auditorius externus, or in the cavity of the tympanum : so 
 that Politzer divides the changes noticed in the membrane 
 into softening of the epidermoid layer, thickening of the 
 same, also thickening of the mucous layer; the first is due 
 to the serous exudation in the meatus, and is as near an idio- 
 pathic myringitis as will be found. True myringitis is a rare 
 disease of the membrane ; being, as has been intimated, sec- 
 ondary to a chronic otitis externa, to a catarrhal, or to a sup- 
 purative, disease of the middle ear. In disease of the external 
 ear, the membrane itself will be dull and thickened, so that 
 the line of the bones will be obscured : whereas, in disease 
 of the middle ear, the mucous surface being affected, will not 
 
LESIONS OF MEMBRANA TYMPANL 2/ 
 
 interfere with reflected light, but will interfere with trans- 
 mitted light ; and, the translucency of the membrane being 
 lost, the incus and stapes will be unseen. Opacities are 
 noticed as the result of disease of the external layer. These 
 are due to changes from suppuration or circumscribed ulcer- 
 ation in the membrane. Opacities of the mucous membrane 
 give a bluish-gray or copper color to the membrana tympani, 
 leaving it opaque, like ground glass. Circumscribed opaci- 
 ties, so-called calcareous deposits, are probably due to the 
 disease of the mucous membrane, fatty degeneration, followed 
 by change into amorphous calcarea carbonica. Tendinous 
 or fibrous opacities cause very slight functional disturbance, 
 and are of less consequence than adhesions between the 
 membrana tympani and the tympanic wall, or between the 
 membrane and the ossicula. This matter will be made clear 
 when your attention is called to cases of perforation of the 
 membrana tympani, or of adhesions between the membrana 
 tympani and the ossicula, healing of perforations, cicatricial 
 appearances, perforations of cicatrices, etc. 
 
 Fracture of the Malleus. Fracture of the Malleus replaced. (Roosa.) 
 
 The membrana tympani may be injured by explosions and 
 by direct violence, by blows, introduction of instruments, 
 etc. 
 
 Artillery-men have suffered from explosions. In most of 
 these cases, it is true that there is an existing catarrh of the 
 middle ear and Eustachian tube. Gruber has demonstrated 
 that the healthy membrana tympani will sustain four or five 
 times the atmospheric pressure. Examinations of workmen 
 
28 LECTURES ON CLINICAL OTOLOGY. 
 
 employed upon the foundation of the East-river Bridge, and 
 also on the St. Louis Bridge, demonstrated the fact, that the 
 laborers who were free from catarrhal diseases did not suffer 
 any trouble in passing through the locks to the caissons, but 
 those who were caught in the attempt at '' changing the 
 ears" (Valsalva's experiment) were subject to catarrhal dis- 
 eases. Blows on the ears, as in the reprehensible practice 
 of boxing the ears, may cause the rupture of the membrane, 
 if it be softened by suppuration. Instances are recorded in 
 which the membrane has been ruptured by twigs being 
 forced into the meatus, and one case is mentioned of rupture 
 by a pen-handle. Rupture of the membrana tympani by 
 attempts at removal of foreign bodies, by excessive efforts 
 in sea-bathing, and as a complication of phthisis, may come 
 under our observation. Fracture of the handle of the 
 malleus is reported by Wier. 
 
 Diseases of the External Ear, — Cases. 
 
 Mrs. John F. P., aged forty years. Otitis externa circiim- 
 scripta. Nov. 19, 1880. Suffered for four weeks with cold. 
 For more than a year has had itching in the ears ; both 
 canals so infiltrated and swollen, that only a partial view of 
 meatus could be obtained ; tissues of the canal infiltrated 
 and oozmg, but more sensitive at some points than at others. 
 Picric acid three times a day, belladoima in water at night, 
 or when the pain is more than usually severe. Under this 
 treatment and local cleanliness, the tissues of the canal 
 cleared up ; but the habit of the tissues, which had been pro- 
 duced by prolonged fomentations, poultices, etc., was not 
 readily overcome. Successive furuncles formed ; and these 
 were evacuated as rapidly as they pointed, no deep incision 
 being made. From the very first exhibition of these reme- 
 dies, the relief was marked ; and the patient gained more in 
 one week than she had previously done in four. 
 
 Dec. 4. The salicylate of qtnnine was given, before meals, 
 to remedy the extreme prostration resulting from this pro- 
 longed tax upon the system. 
 
DISEASES OF EXTERNAL EAR. — CASES. 29 
 
 Mrs. H. Otitis externa diffusa acuta. July 18, 1872. In 
 right meatus, accumulation of scales and cerumen ; canal 
 sensitive ; H. D. right, 3-240 ; left, 20-20 ; removed a portion, 
 and instilled cosmoline. 
 
 July 20. Slight face-ache; H. D. 10-20; pain in mastoid 
 process and on malar bone. Capsicum. 
 
 July 27. Pain again ; slight amount of pus ; H. D. 20-20 ; 
 walls of canals normal. Carbo veg. 
 
 Nov. 20, 1873. Has a similar condition in right meatus; 
 dermoid tissues exfoliating ; inner wall red and tender ; 
 H. D. reduced to a minimum again ; small polypus on the 
 floor of the meatus. Kali sulph. 
 
 Nov. 21, 1874. Continued to improve until to-day; took 
 cold ; every beat of the heart is felt in the ear ; Mt. bulged 
 and red ; very sensitive to air and touch. Hepar stilph., with 
 bellado7tna at night in water. 
 
 Nov. 26. Has improved until to-day ; canal is scaly, with 
 yellow crust. Calc. sidph. 
 
 Dec. 16. Improved until the 12th, when pain set in ; now 
 canal is nearly filled with scales, debris, moist and oozing. 
 Kali phos. 
 
 April 8, 1 88 1. Was relieved entirely by the last treat- 
 ment, and had no attack until to-day ; the canal feels full, 
 and she comes at once for treatment ; the same condition 
 as previously ; the skin of the canal is removed entire with 
 the crust ; the meatus is in better condition after removal 
 than in previous attacks. Kali pJios. 
 
 Jan. 30, 1882. Meatus scaly, congested, slightly sensitive. 
 Kali phos. 
 
 Dr. M., aged thirty-five years. Small ulcer on the upper 
 wall of meatus externns. May 4, 1872. When a child, had 
 ear-ache and offensive discharge. Two years, had three acute 
 attacks of inflammation of the right ear. On examination, 
 the canal is found to be moist, especially the outer third ; 
 the inner portion and the Mt. being free from pus, but rather 
 dull as regards translucence. 
 
 July 8, 1874. The ear has annoyed the gentleman occa- 
 
30 LECTURES ON CLINICAL OTOLOGY. 
 
 sionally ever since last date ; and, on wiping the canal with 
 cotton, a fetid odor to the discharge is always noticeable. 
 It was impossible to get a view of the roof of the canal until 
 I had a polished steel mirror made for me by Philip H. 
 Schmidt ; this introduced through the speculum, the edge 
 of the speculum being brought just within the outer third of 
 the meatus, revealed a small ulcer occupying the space 
 of over five millimetres. The tissues about the ulcer were 
 extremely sensitive to touch, suggestive of localized perios- 
 titis. The ulcer was touched with a saturated solution of 
 the bichromate of potash on cotton. It caused no suffering, 
 but entire relief of the symptoms. Examination at a later 
 date with the mirror showed only a slight depression at the 
 spot where the ulcer had been. 
 
 June, 1883. This gentleman has recently informed me 
 that the one application of bichromate of potash at once and 
 completely cured the whole matter which had annoyed him 
 all his life, and that, too, without the least sign or symptom 
 of local or general disturbance. While I am an enthusiast 
 as regards internal remedies, I should consider myself blame- 
 worthy if I failed to pursue a similar course under similar 
 circumstances. 
 
 Miss E. B., aged twenty-five years. CJironic dermatitis. 
 Dec. 5, 1875. A scrofulous subject; both auricles cracked 
 about the meatus ; the meatus moist and scaly ; the drum- 
 head covered with accumulation of moist scales. Conium 
 mac. 
 
 Dec II. Better; both ears itch; appearance much the 
 same. 
 
 Dec. 17. Intolerable itching in the ears; cracks behind 
 the auricles. Graphites. 
 
 Dec. 24. The same subjective and objective conditions 
 continue. Graphites. 
 
 Dec. 29. Acute diffuse inflammation set up in the left ear. 
 Mercuriiis vivtcs. Diffuse inflammation continued through 
 this month, but under mercurius subsided. In February 
 under graphites again. 
 
DISEASES OF EXTERNAL EAR. — CASES. 3 I 
 
 Feb. 19, 1876. Slight inflammation in the left ear, which 
 yielded to nierciiriiis. This has been the history of the case 
 for a number of years. 
 
 March 9. Tissues have cleared, and dark wax has formed. 
 Coiiiiim med. 
 
 May 26. Has continued to receive co?niim, and is very 
 much improved. 
 
 March 26, 1881. The ears have remained w^ell since 1874. 
 Has a slight catarrhal cold, for which she received viercurius 
 iod. cum. kali tod. 
 
 Mr. T. S. T., aged twenty-seven years. Otitis externa cir. 
 aimscripta acuta. Jan. 14, 1875. For two weeks the right 
 ear has troubled him ; has been dull and stopped, without 
 pain, but with subjective noises ; right meatus closed with 
 soft cerumen; Mt. hidden; H. D. 1-240; two weeks ago 
 he syringed the ear, and brought out some wax. Fluid cos- 
 inoline was instilled in the canal. 
 
 Jan. 18. He had slight pain for two days, and now the 
 ear has been sore for two days ; canal injected, and drum-head 
 slightly injected ; H. D. 18-240. Mercurius dulc. 
 
 Jan. 23. Did not experience as much improvement as the 
 removal of the cerumen would have caused if the ear had 
 been free from middle-ear disease ; H. D. 38-240 ; after Polit- 
 zer, 41-240. 
 
 Jan. 25. Has improved; H. D. Politzer, then 48-240; a 
 furuncle in outer third of the canal. Picric acid, 
 
 Jan. 29. Has improved rapidly; H. D. 16-240. 
 
 July 2. Has been well until this date ; sensation of sore- 
 ness in the right meatus, which is partially closed by another 
 furuncle; H. D. 16-20. Prescribed /zmV ^^z^. 
 
 July 8. All right. 
 
 July 22. All right ; H. D. 20-20. 
 
 April 14, 1876. The same trouble again ; H. D. R. 25-240, 
 L. 5-20 ; cerumen in both canals, and, when it was removed, 
 R. Mt. was found scarred and injected, and the L. Mt, 
 slightly injected ; mucous membrane of the pharynx red and 
 engorged. Mercurius dulc. 
 
32 LECTURES ON CLINICAL OTOLOGY. 
 
 April 20. Much better; H. D. R. 9-240, and L. nor- 
 mal. 
 
 April 28. Ear seems well ; throat slightly sore ; H. D. R. 
 and L. 20-20. MeraiiHus dtdc. 
 
 Miss M. F. M., aged twenty-five years. Otitis externa 
 diffusa chronica. Jan. 22, 1876. Suffered four years ago 
 from intermittent-fever, and ten years ago from scarlet-fever. 
 The meatus is very small on both sides ; and the chronic dif- 
 fuse inflammation was such that the smallest speculum was 
 not admitted, and no view of the drum-head could be ob- 
 tained. The patient had been much worse since the inter- 
 mittent-fever, for which she received large doses of quinine, 
 and had "salt-rheum." She received sulphur^ conitcm, arseni- 
 ctiiHy silicea^ and psorimim at various times, and was under 
 observation until July 8, 1881, at which time both canals 
 were clear ; Mtt. were clear, outlines well defined, and not 
 especially thick, or otherwise abnormal. H. D. for the watch 
 was normal. Under psorinum a vesicular eruption formed 
 in and about the auricle and the temporal region, reaching 
 up into the hair over the mastoid process behind. At one 
 time this extended out well on to the cheek. The vesi- 
 cles ruptured ; yellowish crusts formed on the whole surface 
 involved ; the crusts exfoliated ; and after a month the in- 
 tegument of the auricle and region about the ear became 
 clear, then the right meatus became red. Blepharitis cili- 
 aris set in, which was relieved by allium cepa and rJms, 
 This was followed by severe occipital head-ache, and extreme 
 sensitiveness to the air, relieved by silicea and cimicifuga. 
 Since that time, I have had no occasion to prescribe for the 
 lady. 
 
 Bertha W., aged twenty-nine. Ncevns of the auricle. This is 
 congenital, and illustrates the nature of bloody tumors of the 
 auricle. During her youth it was small ; but, as she expresses 
 it, "since that I stopped growing, it has grown." It is now 
 the size of a large walnut. This case comes as well under the 
 scope of general surgery, and will be sent to Professor Hel- 
 muth's clinic. I will add, in this connection, that, in bloody 
 
DISEASES OF EXTERNAL EAR. — CASES. 33 
 
 tumors of the auricle, the indication is to cut off the supply, 
 form a clot, to prevent deformity. In some cases, the tumor 
 has been laid open, and styptic applications used ; but a large 
 cicatrix may result, the iron salt being retained. In one case, 
 the galvanic current acted well, stopping the supply, leaving 
 no open ulcer, and but little deformity. Any means that 
 will check the blood-supply to the tumor will cure the con- 
 dition.' 
 
 Mrs. G., aged forty. Last April was attacked with erysi- 
 pelas of the scalp, which extended to the auricle and meatus. 
 Its progress was marked by severe pain, loss of hearing, and 
 at length complete deafness, which lasted over a month : then 
 there was a gradual improvement, but the hearing is not as 
 good as formerly. 
 
 This is a case of otitis extejiia, of diffuse character, sec- 
 ondary to erysipelas, extending to the membrana tympani, and 
 undoubtedly involving the middle ear to some extent. You 
 will compare the two ears, and see the uniform capacity of 
 the membrana tympani in the diseased one, in contrast to the 
 normal translucency of the opposite, in which you can trace 
 the outlines of the ossicula. The prognosis is unfavorable : 
 very little change will occur in such a case, but subjective 
 symptoms may be relieved. 
 
 Mrs. McCal., aged forty-five. Otitis externa diffiLsa. It 
 is a case of diffuse inflammation, and illustrated what was 
 said concerning the causes of this disease. Two years 
 ago she was attacked similarly, but in a lighter form ; and 
 she recovered readily. A few days ago she was attacked 
 by itching in the right ear, followed by soreness, and by 
 signs of inflammation. She presented herself yesterday 
 at the Ophthalmic Hospital Clinic, having relapsed to 
 her former condition from scratching that part till inflam- 
 mation was renewed. She complained of intense soreness 
 of the meatus, and of pain and itching : the canal was much 
 
 I Professor Helmuth passed needles through the tissues, outside the base of the 
 naevus, and strangulated it: the mass sloughed without secondary flow, and the ulcer 
 healed with very little deformity. -^ - v^ ,-: .- . . 
 
34 LECTURES ON CLINICAL OTOLOGY. 
 
 swollen, and the inflammation threatened to extend to the 
 scalp. ^ 
 
 This is a typical case of deep-seated inflammation of the 
 external meatus, — diffuse, — involving all the tissues of the 
 canal. I prescribed calcarea picrata, and to-day she is very 
 much improved. Had she desisted from scratching, this re- 
 lapse would probably not have occurred. 
 
 In a case like this, hold the patient as long as possible, 
 induce him to undergo treatment for a long time, and thus 
 overcome the dyscrasia by internal medication. To allay the 
 irritation of the auditory canal, and tendency of the patient 
 to constantly pick the ear, no means is better than the appli- 
 cation of some petroleum preparation, such as cosmoline or 
 vaseline. 
 
 A case has recently been under my care in private practice, 
 — a gentleman afflicted with inflammation of the external 
 ear involving the deeper structure of the skin, as well as the 
 dermoid or epithelial portions. This has decidedly improved 
 under the use of boracic acid trit. locally, and psorimim inter- 
 nally. This case certainly suggested questions concerning 
 Hahnemann's psora theory, and the importance of destroying 
 the dyscrasia. 
 
 I have been surprised by success attained in the similar 
 case of a young lady, also a private patient : therefore I can- 
 not bring her before you, but will detail the case, giving only 
 initials. 
 
 L. C, age sixteen. Subject to catarrhal disease for years. 
 Since puberty has suffered with painful menstruation ; not 
 robust ; has been growing hard of hearing since two years, 
 specially so during the last six months. The hearing for the 
 watch is difficult to settle, because of subjective noises. The 
 voice must be raised, and enunciation be slow ; cannot dis- 
 tinguish what is said when a number of voices are heard ; 
 has granular pharyngitis ; Eustachian tube closed, the left 
 being specially difBcult to force by inflation. 
 
 ^ The inflammation did involve the auricle and scalp. The patient was critically ill 
 for weeks, and the subsequent treatment was more prolonged than in the former attack. 
 
DISEASES OF EXTERXAL EAR. — CASES. 35 
 
 A gargle of sea-salt was ordered to be used three times a 
 day, and inerciwiiLS dulcis administered internally. Politzer's 
 method was attempted twice each week. This continued 
 two weeks without manifest improvement. I detected on 
 close examination near the borders of the hair, especially on 
 those parts subject to tension when the hair was dressed, a 
 vesicular eruption. I inquired if she had an eruption in the 
 hair; and, on receiving an affirmative reply, I examined the 
 scalp, and found this same vesicular eruption through the hair, 
 which looked like "the itch" seen on the hands. It was 
 marked by itching and burning. I stopped the prescription 
 directed against tissue change, and g2x^ psoriimin, a dilution 
 of which I had obtained from that which Dr. Constantine 
 Hering had used in the proving of the virus. At once im- 
 provement began, and has continued to the present time, with 
 good indications for the future. The watch now gives 20-20 
 right ear, 14-20 in the left, with decided gain for the voice. 
 
 Whatever may be the opprobrium cast on your treatment 
 by certain wiseacres, if you can get such results, you can bear 
 the obloquy pronounced by those who will not administer a 
 remedy that has an origin not in keeping with their notions. I 
 will not give remedies on empirical or vague indications ; but, 
 if a remedy have such a proving as this one, I will use it, 
 "whether derived from purest gold or purest filth," as Dr. 
 Bell says concerning this remedy. When you have many 
 such successes constantly occurring in your practice, it will 
 surely impress you strongly that there is something in the 
 homoeopathic law, whatever may be your views as to the 
 theories of miasm, psora, cachexia, or whatever term may be 
 used to explain morbid or curative actions. The success in 
 this showed that there was some cause behind all. I con- 
 sequently questioned the mother at the first opportunity, 
 if she had had any skin-disease ; to which she replied 
 negatively. I pushed my inquiries still farther, and asked 
 whether at school at any time she had contracted an erup- 
 tion ; to which the mother replied that she had contracted 
 an eruption at one time, which showed itself between her 
 
36 LECTURES ON CLINICAL OTOLOGY. 
 
 fingers. The family physician applied sulphur ointment, or 
 something of the sort, and apparently cured the eruption. 
 Can we see any relation of cause and effect, and psorinum 
 effecting the cure } 
 
 There is one thing that the future practitioner must learn, 
 — suppression is not removal ; suppression of eruptive symp- 
 toms, of periodic symptoms, of painful symptoms, is not re- 
 moval ; the abolition of pain by the use of narcotic remedies 
 is often the destruction of the danger signal, — the loss of 
 the clearest indication to the very remedy that will not only 
 remove the symptom, but cure the disease which causes the 
 symptom. 
 
 Cured cases. — Mrs. W. F. L. Otitis £xter7ia parasitica. 
 Aug. 3, 1872. Three weeks ago had pain in the left ear; no 
 relief since. The pain is a dull aching, pressing in every 
 direction, extending to the tongue, throat, and side of the 
 face. H. D. 12-20; right,, -20. Right meatus full of wax; 
 left, the same ; removed that in the right without difficulty ; 
 removed a portion of that in the left, the mass tearing like 
 shreds of paper, leaving the wall tender and oozing. At 
 another sitting in the evening, removed the rest, leaving the 
 wall of the canal and drum-head denuded, and oozing bloody 
 lymph. 
 
 Aug. 4. Pain relieved ; the walls of the meatus and 
 drum-head covered with pus, very sensitive on being dried 
 with cotton ; hears 24-240. 
 
 Aug. 12. The case has been seen each second day until 
 to-day. The question arises. What is this secretion.? — the 
 wall throwing off shreds over the entire extent. 
 
 Aug. 19. The same condition ; shreds not so extensive. 
 
 Aug. 26. Less extensive. Shreds will be subjected to 
 microscopic examination. 
 
 Sept. 2. Canal and drum-head nearly clear. Examination 
 by various powers, 4-10 to 1-15, gave no satisfactory speci- 
 mens of aspergillus therein ; but from the history and symp- 
 toms, as well as from the appearance of the ear, I am sure 
 the case was one of parasitic origin. 
 
DISEASES OF EXTERNAL EAR. — CASES. 37 
 
 Sept. 17, 1877. The last few days the symptoms of Au- 
 gust, 1872, have returned. H. D. right, 20-20; left, c-20. 
 The shreds can be turned away from the walls, and towards 
 the middle of the canal. Seizing the mass with a polypus 
 forceps, it was torn away, leaving the entire canal denuded, 
 oozing bloody cerumen. A few shreds remain at the inner 
 third of the meatus. Applied cosinoline and salicylic acid. 
 The case continued under observation three months. 
 
 Oct. 20. It was dismissed free from any sign of parasitic 
 growth. Another examination with the microscope settled 
 the diagnosis of aspergillus. The patient has been seen at 
 intervals since that day, and the trouble has not returned. 
 
 Mr. T. F. J. Aspergillus glauciis. Oct 14, 1878. Since 
 two months, has been suffering from the pressure of some 
 foreign body in the left ear ; thinks it is an accumulation 
 of cerumen ; right meatus normal ; R. Mt. normal ; left Mc. 
 closed ; removed portions of the shreds morning and even- 
 ing ; submitted to microscopic examination, they gave very 
 satisfactory specimens of aspergillus glaucus. The patient 
 continued under treatment during October and November, 
 the portion being removed, and salicylic acid used as a para- 
 siticide. Cosmoline applied subsequently to overcome any 
 irritation from the acid. There was no reproduction of the 
 growth. 
 
 Another interesting case of this disease, in the form of 
 aspergillus nigricans, occurred in the person of a medical 
 practitioner in this city. He had been suffering for some 
 months with irritation of the left ear, and had syringed it a 
 number of times with no relief, but, as he thought, with rather 
 an aggravation of his discomfort. Examination showed in 
 the inner third of the canal, near the drum-head, a dark-col- 
 ored foreign substance. On touching it with Buck's loop- 
 probe, it was found to be adherent to the floor of the canal ; 
 and some degree of force was required to separate it. On 
 examination with a low power, i-io, it proved to be a very 
 fine specimen of aspe^'gillus nigt'icans. The doctor used a 
 solution of salicylic acid in water, with glycerine, preferring 
 
38 LECTURES ON CLINICAL OTOLOGY. 
 
 that to cosmoline ; and at subsequent visits very minute por- 
 tions were removed by the forcible syringing, after rubbing 
 the seat of the growth with Buck's probe. After repeated 
 trials of the aqueous solution, an alcoholic solution gave com- 
 plete relief, followed with cosmoline to relieve any irritation 
 caused by the acid. 
 
 Mr. E. P. H. Nov. 27, 1872. The history of this case 
 was similar to the preceding ones, save that the parasite 
 found a favorable condition for development in ulceration of 
 the canal, which persisted for a long time after the growth 
 was destroyed by a one per cent solution of carbolic acid. 
 
 The ulceration continued for nearly a year after the de- 
 struction of the growth, although the hearing became 18-20. 
 
 In a case seen at the Ophthalmic Hospital, I obtained the 
 largest mass of fungus that I have ever seen, or removed en- 
 tire from the canal. It was a specimen of aspergillus nigri- 
 cans, was mounted for me by Professor T. F. Allen, M.D., 
 and given to Professor J. W. S. Arnold, M.D , for the pur- 
 pose of having it photographed. Immediately afterwards I 
 was prostrated by severe illness, and for nearly a year was 
 unable to pursue the matter. Upon inquiry, I found that the 
 specimen was taken to Professor Arnold's rooms at the Uni- 
 versity Medical College ; and to his disappointment, as well 
 as my own, the specimen could not be found. 
 
 G. H. B. Ejfects of explosion. Nov. i, 1880. Two weeks 
 ago, a gun exploded near the left meatus, causing slight pain, 
 and a hissing noise set in. The meatus is swollen, the drum- 
 head sodden, the throat red, catarrhal ; H. D. c-20. Bella- 
 donna during the attacks of pain ; Jiepar snlph. every three 
 hours at other times. 
 
 Nov. 3. Very much improved, meatus swollen, tissues dry. 
 
 Nov. 5. Had severe pain last night ; three furuncles in 
 left meatus ; no view of the drum-head ; continued belladonna 
 with picric acid ; much better; furuncles have ruptured, and 
 are oozing. 
 
 Nov. 10. Soreness of the ear rather than pain ; meatus 
 sensitive, swollen. CoYitirnxo, picric acid. 
 
DISEASES OF EXTERXAL EAR. — CASES. 39 
 
 Nov. 12. Hears 12-240; meatus closed by scales. 
 
 Nov. 16. Much improved; hears 19-240; canal clearer; 
 drum-head thick. Kali miir. 
 
 Nov. 22. The same. 
 
 Nov. 26. Not much better ; 27-240. Kali siilph. 
 
 Nov. 29. Has taken severe cold ; hearing not so well ; 
 canal scaly ; drum-head not much clearer ; Eustachian tube 
 dilatable. Continue kali sidph. 
 
 Dec. II. Better; hears 38-240. ContmwQ kali siilph. 
 
 Dec. 22. Better ; hears 42-240. 
 
 Jan. 7. About the same ; hears 42-240. 
 
 Feb. 7. About the same appearance of the canal, and 
 drum-head about the same. 
 
 In this case, I am satisfied that the explosion of the gun 
 was only the last element in a process which had been of 
 long standing, namely, catarrhal disease of the middle ear, 
 and that the acute condition set up was simply superadded 
 to a chronic condition already existing. The patient made 
 only a partial recovery. 
 
 Master George B. F., age eight years. Foreign body. 
 Sept. 5, 1873. One week ago, while at play, put a cherry- 
 stone in his right meatus : efforts had been made to remove 
 it, with no success. The meatus was torn, and any attempt 
 at examination was resisted with all the power the lad could 
 bring to bear. He was etherized ; and, on wiping the canal, 
 the round surface of the stone presented, filling the entire 
 space. A probe bent at right angles was passed between 
 the stone and the posterior wall of the canal, till it could be 
 turned, beyond the stone. Steady traction brought the stone 
 without injury to the walls. Mt. perforated and ulcerated. 
 Arnica. 
 
 Sept. 10. Me, pus, Mt. perf., ulceration the same; Et. 
 dilatable ; tendency to mastoid inflammation. Capsicum. 
 
 Sept. 18. Better; very little discharge of pus ; perforation 
 has clearly defined edges. Silicea. 
 
 Sept. 25. No discharge for two days ; mucous secretion 
 in place of pus. Silicea. 
 
40 LECTURES ON CLINICAL OTOLOGY. 
 
 Oct. I. Improving; discharge slight ; patient gained slow- 
 ly till Oct. 22, when capsicum was given. 
 
 Nov. 19. Discharge ceased; H. D. 3-20; perforation 
 small. 
 
 The father of the lad declined further treatment. I regret 
 not being able to report the final result. 
 
 Diseases of the External Ear. — Summary of 
 Remedies. 
 
 Aconite. — Anxiety ; restless tossing ; sensitive to light 
 and noise ; apprehensive ; fears death ; fulness and heavi- 
 ness of head and brain ; burning, congestive headache ; face 
 bloated, red and hot, but pales on rising ; burning thirst. 
 Indicated usually in the early stages of disease, or when 
 temperature rises in later history. 
 
 Arsenicum album. — In otitis externa diffusa. Objective 
 symptoms : Tissues of meatus red, infiltrated, oozing clear 
 watery fluid, in some cases vesicles, in others the tissues 
 thin, dry, and scurfy. Subjective symptoms : Burning and 
 itching ; itching is aggravated by scratching, and ameliorated 
 by heat. 
 
 The iodide of arsenic has proved more effective in some 
 instances than arsenicum album. 
 
 Antimoninm crndnni. — In cases without objective symp- 
 toms, the subjective ones being heat and tension, aggravated 
 by heat. Otitis media catarrhalis chronica, left ; with the 
 symptoms due to lesion of the middle ear. The heat of 
 the auricle and meatus was increased by sunlight ; heat from 
 the stove, wrapping, or even turning upon that side in sleep, 
 would increase the heat, and waken the patient. Antimo- 
 ninm crudum caused transfer of the heat to the scalp. 
 Glonoin has since controlled the latter condition. 
 
 Belladonna. — Beating headache ; throbbing in brain, with 
 sensation as if it were loose in forehead ; worse from walking 
 or rising ; head sore to touch ; tearing pains in ear ; mouth 
 dry and hot ; posterior wall of pharynx dry and glazed ; 
 bright red. The fever is marked by alternate chill and heat. 
 
DISEASES OF EXTERNAL EAR. — REMEDIES. 4 1 
 
 or internal chill with external burning. The patient starts 
 suddenly, rather than constant motion. (Compare aconite, 
 ferrum, and gelsemium.) 
 
 Calcarca cai'bonica. — One of the most valuable remedies 
 in suppurative inflammation of the external ear, in scrofulous 
 subjects. The meatus filled with cheesy pus, the derma 
 thickened and red. Often the dermoid layer of the mem- 
 brana tympani destroyed by ulceration, and covered with 
 exuberant granulations, which may fill the meatus, the struc- 
 ture of these polypi being of the simple cellular class. There 
 is a lack of subjective symptoms: in some a pulsation is 
 noticed. 
 
 Calcarea picrata. — Indicated by clinical experience for peri- 
 follicular inflammation. The extreme prostration of picric 
 acid is relieved by this salt, also. 
 
 Carbo vegetabilis is indicated in otitis externa diffusa 
 chronica ; objective symptoms being a dry furfuraceous 
 eruption, a pityriasis, thin, dry epithelial scales thrown off, 
 unattended with marked inflammatory signs. In some cases 
 the detritus is moist, yellow, and fetid. Subjective symp- 
 toms : Itching and heat deep in the ear as well as in the 
 meatus, causing an inclination to swallow. The ears feel 
 stopped. These symptoms suggest the relation of the meatus 
 to the tympanum and Eustachian tube. Carbo veg. is valu- 
 able in granular pharyngitis with the above symptoms, the 
 expectoration being small masses of mucus, easily raised. 
 Under the use of carbo veg. the secretion of wax is re- 
 established in many cases. 
 
 CJiamomilla is of value when the patient is extremely in- 
 tolerant of pain. Specially valuable in diseases of children 
 and sensitive female adults. 
 
 Coniiwt maadattim. — Valuable in hypersecretion from the 
 ceruminous glands. Objective symptoms : Accumulation of 
 soft cerumen, of normal color, and clinically, that which 
 resembles mouldy paper, and is mixed with pus. The sub- 
 jective symptoms are a sense of fulness, roaring, and hum- 
 ming ; diminution of hearing, which is ameliorated, in many 
 
42 LECTURES ON CLINIC A I OTOLOGY. 
 
 cases, by pulling the auricle, as this straightens the canal, 
 and makes a passage for the sound-waves beside the mass of 
 cerumen. 
 
 Ferriim phosphoriciim. — From Schiissler's "■ tissue reme- 
 dies : " to be given in the early stages of inflammation, or 
 later when temperature rises, and pulse increases. One 
 guiding symptom observed clinically is the noticeable pulsa- 
 tion in the ears : every impulse of the heart is felt there. 
 Compare aconite. 
 
 Graphites. — The characteristic symptoms of this remedy, 
 as regards the integuments and nails, are noticeable in this 
 locality. The objective symptoms are dryness and cracking 
 of the tissues of the meatus and auricle, particularly behind 
 the latter ; deep fissures in many cases. The pus, both in 
 the meatus and about the auricle, is usually thick, and forms 
 crusts very rapidly. The subjective symptoms are itching 
 and soreness, not to the degree that may be called sensitive 
 (see hepar). 
 
 Hepar siilpJmriLS calcarea. — The appearances that suggest 
 this remedy are those of an indolent ulcer, corroding, and 
 very sensitive to touch ; the pus fetid and thin, or, if the 
 membrana tympani be perforated, mingled with mucus. The 
 subjective conditions are itching in the meatus, with sore- 
 ness on attempting to bore with the finger. Better by 
 wrapping. 
 
 Kali nuLriaticinn (Schiissler). — Chronic dermatitis ; moist, 
 excessive exfoliation of epithelial layer ; in ulceration, pus 
 whitish ; granular conditions of inner third of meatus and on 
 Mt. 
 
 Kali phospkoricum (Schiissler). — Atrophic conditions in 
 old people, tissues dry, scaly ; lack of vitality. 
 
 Kali sidphiirictLvi (Schiissler). — Conditions similar to the 
 muriate : the bright yellow color of the pus is a guiding 
 indication. 
 
 Merairius viviis. — Although this remedy is specially indi- 
 cated in diseases of the middle ear, yet it may be used as an 
 intercurrent remedy in disease of the meatus, with conium 
 
DISEASES OF EXTERNAL EAR, — REMEDIES. 43 
 
 and carbo vegetabilis. In January, 1873, we treated Mrs. 
 T., aged forty-eight, a thin, small woman, dark hair and eyes. 
 Had discharge from R. since childhood. One month later 
 took cold, and lost the power in the L. Hears voice 20-80 ; 
 watch, 2-240 R. and L. Me. ext. scales and shreds ; R. Mt. 
 irregular, retracted, but movable ; Et. dilatable ; throat granu- 
 lar. The outermost dermoid layer of the membrana tympani 
 was repeatedly thrown off during the course of treatment, 
 the meatus filling with cerumen and scales. Carbo veg. and 
 conium made remarkable change in one year, the hearing for 
 voice becoming nearly normal; watch, R. 10-240; L. 10-240. 
 The second year she was seen at intervals of about two 
 months. During the third year, on one occasion, some of 
 the shreds were accidentally carried very near the terminal 
 filaments of the olfactory nerve, and the decided coppery odor 
 was noticed. Merc, was given with most marked relief to 
 the local as well as general condition of the patient. 
 
 Mezereitm. — This remedy is very effective in relieving 
 intense itching in the auditory meatus. The sensation 
 extends to the Eustachian tube. (Compare causticum and 
 nux vomica.) One guiding symptom is the sensation *'as if 
 the cold air reached the tympanum." 
 
 Picric acid. — This remedy is indicated by the recent prov- 
 ing in furuncular or circumscribed inflammation of the mea- 
 tus ; yet, in the chronic or subacute forms, it has delighted 
 patients and surgeons. In debilitated cases, with redness 
 and localized tenderness of the meatus, it acts like magic. 
 
 Plantago major. — For local use, to mitigate the intense 
 pain of circumscribed or diffuse inflammation. (Compare 
 middle ear.) 
 
 Psorimim. — External ears, raw, red oozing ; scabs form ; 
 sore pain behind ears. Otorrhoea very offensive, purulent, 
 watery. Pustules on and behind concha. Scabby eczema 
 behind right ear. Herpes from ears to cheeks. Scurfs form, 
 and scale off ; yellow discharge from under scurfs ; itching 
 intolerable. This remedy has been repeatedly confirmed, 
 both in clinical and private practice. 
 
44 LECTURES ON CLINICAL OTOLOGY. 
 
 Pulsatilla. — Specially indicated in circumscribed inflam- 
 mation in sensitive women, with extreme chilliness ; darting 
 pains, worse in the evening ; better by exposure to cool air. 
 (Compare hepar.) 
 
 Silicea corresponds to an ulceration of the tissues of the 
 membrana tympani and inner extremity of the meatus, which 
 is deep, slow to heal, covered with thick yellow pus : the pus 
 tends to the formation of a firm scab, which adheres closely 
 to the ulcer, and, on removal, reveals the above condition. 
 The tenderness is marked on touching with probe and 
 cotton, but not so extreme as hepar sulph. calc. One sub- 
 jective symptom that suggests this remedy is a hissing 
 sound accompanying the purulent discharge. 
 
 Sulp/mr. — This remedy applies to many and varied, some- 
 times opposite, conditions. The appearance of ulceration, 
 with perforation of the Mt.y is usually thick edges, with thin 
 pus, fetid, tending to crusts. The ulcers show no disposition 
 to heal. Subjective symptoms are burning and itching, or 
 pricking ; a sensation of tension or drawing deep in the mea- 
 tus, or a pulsation in the same, would suggest the remedy ; 
 but these objective and subjective symptoms are usually 
 most marked in diseases of the middle ear. 
 
 Tellurium is of great value in acute inflammation of auricle, 
 meatus, and external surface of membrana tympani, — a con- 
 dition similar to phlyctaenular conjunctivitis ; yet the remedy 
 has proved curative in chronic suppurative inflammation, 
 with the characteristic discharge, watery, excoriating, and 
 very fetid, smelling like fish-pickle. The condition of tissues 
 in the prover. Dr. Carroll Dunham, indicates that it should 
 cure suppuration of the middle ear as well. 
 
Part Second. 
 
 DISEASES OF THE MIDDLE EAR. 
 
FOURTH LECTURE. 
 
 ACUTE CATARRHAL INFLAMMATION OF THE MIDDLE EAR. 
 
 Gentlemen, — The nomenclature of diseases of the middle 
 ear is a matter of importance ; for, if it be true that language 
 is necessary to thought, a clear and definite classification 
 will help us to avoid erroneous ideas of disease. 
 
 I shall follow the classification suggested by Professor 
 Roosa : First, acute catarrhal inflammation ; second, sub- 
 acute catarrhal inflammation ; third, chronic non-suppurative 
 inflammation, in the two forms, catarrhal and proliferous ; 
 fourth, acute suppurative inflammation ; fifth, chronic sup- 
 purative inflammation ; sixth, consequences of chronic suppu- 
 rative inflammation. 
 
 Catarrhal inflammation is not a local, but a constitutional, 
 disease, and requires constitutional treatment. It is impossible 
 to deal successfully with these catarrhal diseases, unless we 
 attend to the detail of hygiene. At times we may use reme- 
 dies alone, and meet with good results ; while, again, we may 
 fail because of neglect in the direction of hygiene. There is 
 a tendency, on the part of many practitioners, to follow a 
 routine in all cases that come to them, never leaving a cer- 
 tain fixed mode of practice. It is to this routine mode of 
 treatment that so many failures in the cure of disease are 
 chargeable, whether it be directed towards hygiene alone, 
 excluding medicine, or the use of medicine, excluding the 
 essentials of personal and general hygiene. To impress 
 more fully the importance of careful investigation in every 
 instance, let me refer to a case : — 
 
 47 
 
48 LECTURES ON CLINICAL OTOLOGY. 
 
 A lady came to me who had for two years been suffering 
 from what was said by a number of physicians to be catarrh. 
 It was catarrh treated in the routine way, "powders, pow- 
 ders, powders." The patient had never been subjected to 
 an examination of the naso-pharyngeal tract. On investiga- 
 tion, I found the nares filled with gelatinous masses which 
 perpetuated the condition. It was necessary to use local, 
 mechanical, and constitutional means to bring about a cure. 
 
 Statistics should show that AcuU Catarrhal Iiiflaimiiation 
 of the Middle Ear is a very frequent form of disease, though 
 it is not so reported. Many a serious result, affecting the 
 hearing of the adult, may be traced to what may be con- 
 sidered a trivial affair in the child, ''only an ear-ache." 
 
 Symptoms. — The symptoms of acute catarrhal inflamma- 
 tion are pain, fulness, noises. Objective symptoms are in- 
 jection of the membrane, bulging of the same, impairment 
 of hearing, naso-pharyngeal catarrh, general fever. The 
 pain is deep-seated, usually severe at night, mitigated dur- 
 ing the day, and often leading the patient to suppose that 
 his trouble has passed : it may pass, but only to return with 
 the approaching night, and, unless treated, grows more and 
 more severe on successive nights, until it passes into the 
 exudative form of disease, or on to the suppurative form. 
 The sense of fulness may precede the pain for days, and is 
 often associated with itching. This pressure increases from 
 day to day, until the pain ensues. Often, before the pain, 
 subjective noises will be recognized ; but the impairment of 
 hearing is not usual until after the pain has set in. On 
 inspection, the membrana tympani will be found injected, 
 especially about the handle of the malleus, Shrapnell's mem- 
 brane, or its entire periphery. This injection may pass 
 away, and resolution occur without more serious symptoms. 
 Later the injection amounts to absolute congestion of the 
 entire membrane; and, as the accumulation increases in the 
 cavity of the tympanum, the inward concavity of the drum- 
 head will be changed to a bulging into the canal. This may 
 be excessive, and if relieved by paracentesis, and removal of 
 
ACUTE CATARRHAL IXFLAMMATIO.V. 49 
 
 the accumulated secretions of the tympanum, will be entirely 
 overcome as the case progresses to resolution. 
 
 Diagnosis. — The impairment of hearing is very great in 
 many mild cases, and is a strong diagnostic point between 
 otitis and otalgia neuralgica. In all cases, there is more 
 or less naso-pharyngeal catarrh, this being the remote cause 
 of the middle-ear disease. Febrile disturbance is another 
 symptom which will enable you to decide between otitis and 
 otalgia. The rapid pulse and high temperature are not found 
 with otalgia. 
 
 Causes. — The causes of acute inflammation of the middle 
 ear are those of catarrh in general ; and, when we enter upon 
 this field of investigation, we find it very wide. Climatic 
 conditions, personal habits, clothing, bathing, eating and 
 drinking, all are involved in this discussion. It is noticeable, 
 that on the Atlantic belt, on the river-courses, and in the 
 lake regions, there is a general complaint that the excessive 
 moisture interferes with the function of the skm, to such a 
 degree that the mucous membranes of the body have to do 
 double duty : such being the case, only the most rigid regi- 
 men as to personal habits, clothing, and food, will so sustain 
 the functions of the external surface of the body that inter- 
 nal organs will not be burdened. Space will not suffice to 
 consider in all its bearings the matter of climate ; but, in 
 general, a dry, uniform atmosphere will overcome the disease, 
 even in serious cases, when a change of location is feasible : 
 if not, all means which will preserve the function of the skin 
 must be carefully employed. Bathing is a matter which has 
 been abused, yet it is one of the most important of personal 
 habits. Excessive bathing frustrates the very object in view. 
 Persons are exhausted by excessive bathing, as ^they lack 
 power of re-action ; and hence their vitality is drawn upon to 
 a degree which in some cases has been fatal. A warm bath 
 once a week is sufficient for personal cleanliness; but a tepid 
 bath at night if the subject has a low degree of vitality, or a 
 cool bath in the morning if the patient be otherwise vigor- 
 ous, with hand-rubbing, or rubbing with a coarse towel over 
 
50 LECTURES ON CLINICAL OTOLOGY. 
 
 the entire body, until re-action ensues, is invaluable. The 
 clothing should be such as to allow ready elimination of the 
 insensible perspiration, and yet of such material as to pre- 
 vent radiation of the animal heat. Special attention should 
 be given to the clothing of the extremities and feet. Many 
 a catarrhal patient, especially among women and children, 
 is wrapped and bundled about the trunk of the body, while 
 the extremities suffer from exposure. 
 
 I am satisfied that one's habits, in the matter of food and 
 drink, have much to do with the excessive accumulation of 
 mucus. While I am not an advocate of an exclusively 
 vegetable diet, I am satisfied by personal experience, as by 
 observation, that excess of animal diet, especially when of a 
 stimulating nature, and associated with stimulating drinks 
 and the use of narcotics, is a most potent factor in the supply 
 of material which must undergo destructive metamorphosis ; 
 as it can serve no part in the maintenance or upbuilding of 
 the tissues of the human body. Diseases of a catarrhal 
 nature which affect the pharynx, must necessarily involve 
 the Eustachian tube, and are the direct cause of middle-ear 
 diseases. Among the most noticeable direct causes of acute 
 inflammation of the middle ear are the use of the nasal 
 douche, and snuffing water. 
 
 Prognosis. — Unfavorable, if under adverse climatic con- 
 ditions ; favorable, with the best conditions, and with such 
 treatment as later years have demonstrated to be practicable. 
 
 Treatment, medicinal. — Belladonna, chaniomilla, gelseni- 
 inni, Jiepar snlph. calcarea, merc?irins, and piUsatilla will be 
 indicated in acute catarrhal inflammation, — the first three 
 and the last for the mitigation of pain, the other two against 
 the destructive changes of tissue. 
 
 Belladonna is indicated when the pain is shooting, beating, 
 darting, associated with marked chilliness, not especially 
 marked thirst, and great restlessness. 
 
 CJiamomilla is more particularly indicated in children, or 
 when the patients are very intolerant of pain, being unable 
 to control themselves under what seems rather trivial suffer- 
 ing. 
 
ACUTE CATARRHAL INFLAMMATION. 5 I 
 
 Gelsemmm is especially for the more apathetic, quiet con- 
 dition, fever not marked, the patient inclined to stupor, the 
 head-symptoms being those of pressure and tension, relieved 
 by outward pressure or binding. 
 
 Pulsatilla is indicated in women and children, persons of 
 an extremely sensitive nature, and in those cases where there 
 is relief of most symptoms from being in the open air. 
 
 Hepar stUph, calcarea will often ward off suppuration when 
 the patient is extremely sensitive to air, and is relieved by 
 wrapping, and by warm, dry applications. This is in contrast 
 to merciirms, under which remedy the patient suffers with 
 excessive perspirations of a sticky or greasy nature, which 
 do not relieve the general suffering, but annoy the patient. 
 The perspiration is similar to that of mercurius cases, when 
 hepar relieves, but not so general or continuous. There is 
 often, with the hepar patient, a localized tenderness of the 
 tissues about the ear, especially in front ; whereas, in mer- 
 curius, the tenderness is more general about the ear, and 
 extends down the neck beside the jaw. Careful study of 
 symptomology will often suggest some other remedies, but 
 these are more usually indicated. 
 
 Instrumental means of treatment. — Warm applications are 
 usually very grateful, — dry heat in the form of the salt-bag, 
 or warm vapor, warm water dropped into the meatus from a 
 sponge, drop by drop, as warm as can be tolerated. This is 
 made more effective by the addition of a few drops of aco- 
 nite^ belladonna^ or plantago. Some writers have advised the 
 use of warm applications in the form of poultices, or fomen- 
 tations of herbs, especially of hops This is reprehensible 
 practice : suppuration is often induced by such applications. 
 Some of the worst cases of suppurative disease, involving 
 the mastoid, have resulted from the abuse of warm, moist 
 applications. 
 
 Paracentesis of the membrana tympani has been advised, 
 followed by inflation, and removal of the mucus. I be- 
 lieve, however, that the use of the indicated remedies, with 
 inflation by Politzer's method as soon as practicable, will, in 
 
52 LECTURES ON CLINICAL OTOLOGY. 
 
 the vast majority of cases, cut short the attack without para- 
 centesis, and that the mucous accumulations will be ab- 
 sorbed. Later treatment, as prophylactic, must bear upon 
 the naso-pharyngeal condition. 
 
 Subacute catarrhal iiiflaimnation is, strictly, either the 
 antecedent of the acute form, or the resultant of an acute 
 inflammation, standing between resolution on the one hand, 
 and chronic catarrhal inflammation on the other. 
 
FIFTH LECTURE. 
 
 CHRONIC CATARRHAL INFLAMMATION OF THE MIDDLE EAR. 
 
 Gentlemen, the next subject in the order of our classifi- 
 cation is CJironic Catan'Jial Iiijiainmation of the Middle Ear. 
 
 History. — It is necessarily the successor of repeated at- 
 tacks of acute catarrhal inflammation, or of subacute catarrhal 
 inflammation if the patient should be fortunate enough to 
 escape acute suffering ; and yet we can hardly say, " fortunate 
 enough," because acute symptoms often lead to a careful 
 investigation of one's condition, and the recognition of a sub- 
 acute or chronic phase of the disease. I desire to impress 
 upon your minds the very great importance of an early rec- 
 ognition of this condition. The fact that it is gradual, and 
 insidious in its approach, is the serious feature of its history. 
 The degree of hearing that one may lose, and yet be unaware 
 of the failure of the function, is very remarkable. In this 
 respect, disease of the middle ear stands in marked contrast 
 to disease of the eye. 
 
 The effect of cold upon the eye in causing congestion is 
 at once recognized, even in the less grave affections ; as con- 
 junctivitis, superficial keratitis, etc., receives prompt atten- 
 tion, and that attention continues until a cure is reached. 
 Similar congestion of the middle ear may occur again and 
 again, and be neglected until tissue changes take place, 
 which it is impossible to overcome in the later stages of the 
 disease. The reasons why this is impossible, I shall en- 
 deavor to emphasize by calling your attention to these charts 
 of the middle ear, showing you the relation between the 
 
 53 
 
54 LECTURES ON CLINICAL OTOLOGY. 
 
 membrana tympani, the tympanic walls, and the ossicula 
 themselves. Let me assist you by calling your attention to 
 the diagram which I will sketch upon the board. 
 
 You will notice the plane of the membrana tympani in a 
 normal condition, as shown by the cross-section cut perpen- 
 dicularly through the middle of the tympanum. This divides 
 the ossicula nearly in the middle ; and you will understand, 
 that, if any cause acts to close the passage of air by way 
 of the Eustachian tube, there is no atmospheric pressure to 
 counterbalance the pressure exerted upon the drum-head by 
 the external air. Thus, the drum-head is forced inward, the 
 handle of the malleus approximating to the incus and to 
 the tympanic wall. Now, if to this pressure, as an element 
 of the change of relation of these parts, there be added 
 changes in the structure of the membrane itself, you will 
 see, that, by relaxation, it may be actually in apposition with 
 the thickened mucous membrane of the tympanic wall. When 
 this occurs, adhesions form, similar to adhesion between the 
 pleura pulmonalis and pleura costalis in pleuritis. When 
 these adhesions are established, they remain through life. 
 Various operations have been suggested, as we shall see when 
 speaking of instrumental treatment ; but they have proved 
 futile in most instances. One of the earliest, most persist- 
 ent, most annoying results of this adhesive process is the 
 production of subjective noises. If you will close your eyes 
 while sitting here, and repeatedly strike or press your fingers 
 upon the closed eyelids, you will understand by analogy what 
 takes place with every vibration caused by similar pressure, 
 if the stapes be forced upon the labyrinthine fluids. Now, 
 this subjective condition is one of the earliest intimations in 
 the history of chronic catarrhal disease ; and I desire to en- 
 force this point, that you may not neglect it when you have 
 to deal with it in practice. It is true that this condition may 
 occur when not associated with chronic catarrhal disease, as 
 in prostrating diseases, associated with great loss of blood, 
 anaemia, or vertigo and faintness, secondary to some or- 
 ganic disease. But a careful study of these cases will reveal 
 
CHROXIC CATARRHAL IXFLAMMATIOX. 
 
 55 
 
 Sectioi^ of the Head, showing the Divisions of the Ear and the Naso i-harvngeal 
 Cavitv. (After a Photograph. Rudinger.) 
 
 . Cartilage of external auditory canal. 2. Osseous auditory canal. 3, 4. Membranae tympa- 
 nortim. 5. Cavity of the t;,mpanuni. 6. Dilator muscle of the Eustachian tube. 7. Levator 
 palati muscle. 8. Mucous membrane of the pharyngeal orifice of the tube. 9. Left membrana 
 tympani. 10. Handle of the malleus and short process. 11. Tensor tympani muscle. 12. 
 Mucous membrane of the membranous portion of the tube, perforated by a needle. 13. Levator 
 veli palati muscle. 14. Mucous membrane of the posterior surface of the pharynx. 15. Mu- 
 cous membrane of the pharynx, attached to the lower surface of the body of the sphenoid 
 bone. 16. Sphenoidal sinus. 17. Hypophysis cerebri, and its relations to the cerebral arte- 
 ries and the cavernous sinus. (From Roosa's Treatise.) 
 
56 LECTURES ON CLINICAL OTOLOGY. 
 
 sufficient causes for the subjective symptoms ; whereas, in 
 chronic catarrhal inflammation, you will not usually fmd other 
 explanation than that which is here given. 
 
 In the classification of the disease of the middle ear, which 
 has previously existed, we find a great variety of termiS ex- 
 pressive of the condition : for instance, sclerosis, otitis media 
 hypertrophica, otitis media hyperplastica, tubal catarrh, tym- 
 panal catarrh, proliferation. The first is a correct translation 
 of expressions used by Continental writers ; the second and 
 third, of some Continental and English aurists ; tubal catarrh 
 and tympanal catarrh have been used by English writers 
 mostly ; while proliferous inflammation is a term used by Pro- 
 fessor Roosa to cover the whole field of symptoms and con- 
 ditions which stand in contrast to the catarrhal condition, 
 primarily and simply. Grouping these together, I have here 
 placed, in contrast to them, the two terms, catarrhal and post- 
 catarrhal ; as the term post-catairJial is, to my mind, descrip- 
 tive of a large majority of these cases. While it is true that 
 we may not always be able to trace the history of the early 
 catarrhal experience, as the term implies, yet it is true that 
 in many cases we are able to do so ; and the later history 
 has been one of retrograde metamorphosis, absence of secre- 
 tion, dryness, sclerosis, and, subjectively, of all the features 
 of the cases which were previously grouped under those 
 descriptive terms. 
 
 By ''catarrhal," then, we understand that division of 
 chronic catarrhal inflammation of the middle ear which is 
 characterized by excessive secretion ; and by "post-catarrhal," 
 the group of cases which stand in marked contrast to the 
 former. The catarrhal form corresponds to what some writ- 
 ers have called Jminida, and the post-catarrhal to that which 
 some writers have called sicca. 
 
 Subjective symptoms of the catarrhal form. — Secretion in 
 the posterior nares, pharynx, Eustachian tube, and tympa- 
 num. Its progress is not insidious. It is characterized by 
 fulness of all the naso-pharyngeal tract. Sounds in the ear, 
 not necessarily excessive. People are said to speak low. 
 
CHRONIC CATARRHAL INFLAMMATION. 57 
 
 Subjective symptoms of the post-catarrhal form. — Very little 
 secretion in the naso-pharyngeal tract ; the loss of hearing 
 being the earliest, and sometimes the only fact, which the 
 patient has noticed. The naso-pharyngeal tract characterized 
 by thinness of the tissue ; the auditory canal the same, dry, 
 and enlarged in calibre. The subjective noise is excessive, 
 and very distressing ; and you will often find associated with 
 this, the peculiar symptom of the person hearing better in a 
 noise. The explanation of this symptom has been attempted 
 by various authors. The one which is most satisfactory to 
 my own mind is, that the greater vibrations caused by loud 
 noises, as the sounds of machinery, the rattle of cars, etc., 
 bring into vibration the entire auditory mechanism, and, while 
 it is then in functional activity, the lesser vibrations are con- 
 veyed and recognized ; which is not the case when the patient 
 is in a perfectly quiet room. 
 
 Objective symptoms of the catarrhal form. — Deafness ; also 
 objective changes in the membrana tympani, as thickening 
 and opacity. Changes in the tympanum, by which its walls 
 are increased in thickness, and the calibre necessarily dimin- 
 ished : the Eustachian tube is similarly affected. The same 
 is noticed in the naso-pharyngeal tract. The diameter of 
 the auditory canal is usually normal. 
 
 Objective symptoms of the post-catarrJial form. — The same 
 contrasts are noticed, which you will more clearly understand 
 when we consider the pathological features. 
 
 PatJiological changes, catarrhal form. — First, thickened 
 mucous membrane; second, excessive mucous secretions ; 
 third, lymphy secretions. 
 
 Pathological changes, post-catarrhal form. — Connective tis- 
 sue changes, binding the mucous membrane in various di- 
 rections. The bony walls hypertrophied, Eustachian tube 
 obstructed by bands ; stapes anchylosed, exostoses, incus 
 and malleus anchylosed, mastoid cells closed by bands, ten- 
 don of the tensor tympani muscle adherent to the ossicula, 
 or to the tympanic wall ; atrophic degeneration of the tensor 
 tympani muscle. While it has been shown, that, even in the 
 
58 LECTURES ON CLINICAL OTOLOGY. 
 
 foetus, there are similar formations, yet it is also shown that 
 these are absorbed in the early life of the child ; and it is 
 begging the question to assert that the formations in the 
 post-catarrhal form are coincident with foetal life, for any 
 careful observer will admit that he has seen these changes 
 grow more and more marked in cases which I have called 
 post-catarrhal. 
 
 Causes. — The same causes which are effective in acute 
 catarrhal disease are also potent here, and should receive the 
 same attention. Phthisis, syphilis, scrofula, in fact any 
 cachexia tending to degeneration of tissue, to metamorphosis 
 either in the direction of excess or deficiency, will lie at the 
 foundation of these two forms of disease. The remote causes 
 are those which lie far back, in the acute or subacute ca- 
 tarrhal attacks. There is a certain class of cases which have 
 caused considerable discussion, in which the sudden failure 
 of function would seem to be due to a sudden loss of nervous 
 force. Pregnancy has seemed to be the exciting cause in 
 not a few of these cases ; each parturition being marked by a 
 greater loss of function,- — a loss which is seldom repaired to 
 any extent. In some cases, I have been unable to attribute 
 any cause for the sudden and irreparable partial loss of func- 
 tion. Any means which would act temporarily to increase 
 the tone of the nervous energy of the individual, would cause 
 corresponding temporary improvement of the function. 
 
 Treatment. — Instrumental and medicinal. The treatment, 
 as regards both instrumental and medicinal methods, will be 
 divided according as the case is one of catarrhal, or so-called 
 post-catarrhal, nature. For the catarrhal strictly, much may 
 be done ; for the post-catarrhal, — save in a few instances, 
 where the muscular tissues can be restored to partial func- 
 tion, — very little, from the nature of the case, has been, or can 
 be, accomplished. First, consider the purely catarrhal cases. 
 The treatment should be directed to overcome the excessive 
 secretion, and to the reduction of the thickened mucous 
 membrane, thereby increasing the calibre of the tympanum 
 and the Eustachian tube ; and, to be in keeping with our 
 
CHRONIC CATARRHAL INFLAMMATION. 59 
 
 views of treatment, this must be done mainly by internal 
 medication. You will understand, therefore, why I consider 
 as worse than useless, persistent interference with the mu- 
 cous membrane of the pharynx and Eustachian tube, by for- 
 cible means of dilatation, and acrid or caustic applications to 
 the same region. It has occurred that the continuous exhi- 
 bition of the clearly indicated remedy has so reduced the 
 thickened mucous membrane, and restored the patency of 
 the Eustachian tube, that the function of the same has been 
 suddenly restored, without instrumental interference. The 
 patient has experienced the subjective symptom of a loud 
 explosion or detonation in the head, and, to his delight and 
 astonishment, has found his function measurably restored. 
 If much can be done, and is done, by our friends of the op- 
 posite side when using mechanical treatment simply and 
 purely, much more can be done by us when instrumental 
 treatment is supplemented by indicated remedies. The use 
 of the various instruments for inflation will be shown in con- 
 nection with cases. I therefore pass to a description of vari- 
 ous operative procedures, which have been suggested, and 
 show why they have almost universally failed to be of value. 
 
SIXTH LECTURE. 
 
 CHRONIC CATARRHAL INFLAMMATION OF THE MIDDLE EAR 
 
 CONTINUED. 
 
 Gentlemen, — Great stress is justly laid by some writers 
 upon the constitutional treatment as well as the hygienic 
 care of the patient ; but beyond the administration of forms 
 of potash and lime, in massive doses, there is little to be 
 obtained from the so-called "regular" literature which will 
 be helpful to us. One conclusion which the best authors 
 reach, is that applications of a caustic or escharotic nature 
 are admissible only in the catarrhal form. What I have said 
 in regard to the use of the douche as an instrument of treat- 
 ment, holds good in the chronic catarrhal form. While it is 
 true that there is a temporary relief of the naso-pharyngeal 
 symptoms, the method is a great source of danger. The 
 same is true of Gruber's method, which consists of injecting 
 various medicated fluids by using a small-bulb syringe ; in- 
 troducing the tip into the anterior nares, and forcing the 
 contents through into the pharynx. When it is desired to 
 flood the tympanum, the patient's head is turned toward 
 the side which it is desired to flood ; and he is instructed to 
 hold the nose, and blow, while the head is down. Bear in 
 mind that this should never be done without the full recog- 
 nition of the dangers involved, and the necessity that the 
 patient should be kept under the surgeon's eye, that he may 
 guard him against any acute disease, — by the use of inflation 
 to dissipate the contents of the tympanum into the mastoid 
 cells, or outward again by the way of the Eustachian tube. 
 60 
 
CHRONIC CATARRHAL INFLAMMATION. 6 1 
 
 These passages and cavities are, by nature's arrangement, 
 for air only ; and air or vapor is better adapted as a medium 
 of medication. 
 
 Bo2tgies are inadmissible. The fact that the Eustachian 
 tube, in its inner extremity, passes through bony walls, in- 
 creases the difficulty of the passage of a bougie, and thereby 
 makes it a less feasible instrument than in the treatment of 
 other narrow passages of the body. In connection with the 
 cases to which I have already called your attention, the use 
 of electricity was mentioned as a means of stimulating the 
 degenerated muscles of the tympanic cavity, and I urge you 
 to qualify yourselves to properly apply this useful and yet 
 dangerous agent : you will obtain gratifying results in those 
 cases which have the factor of degenerated muscular tissue 
 as one of their prominent lesions. 
 
 The question may arise. How long, or when, is it advisable 
 to treat cases ? Persons suffering from this form of disease 
 must understand that they will require every year more or 
 less attention. It will be impossible to gain any degree of 
 audition, or even to retain the remaining degree, without 
 attention some portion of the year. During the cold season, 
 repeated exposures will cause an accession of serious symp- 
 toms. These must be watched and treated. During the 
 time of the constitutional change, which a person undergoes 
 in the spring or early summer months, I am satisfied that we 
 can render these patients more service than at any other 
 time of the year. During the summer they will need very 
 little care, and usually will not retrograde until the late fall 
 or early winter months. Therefore, by careful attention, you 
 will be enabled to protect from complete loss of function, 
 and possibly add each year a little power to that existing 
 when first seen. 
 
 The next item of treatment we have to notice is that of 
 the various, operations upon the membrana tympani. So far 
 back as 1650, the question was raised, whether incision of 
 the membrane would be a justifiable and useful operation. 
 As early as 1760 the operation was made by one Eli, whom 
 
^2 LECTURES ON CLINICAL OTOLOGY. 
 
 Roosa reports as probably a charlatan. To Sir Astley 
 Cooper is due the introduction of the operation, and demon- 
 stration of its advantages. It fell, however, into disrepute, 
 but was revived by Schwartze for acute troubles, removal of 
 mucous accumulations, etc. 
 
 Politzer, in 1845, suggested the introduction of the eyelet 
 into the membrane ; because it was found by Schwartze and 
 others next to impossible to maintain a permanent opening. 
 Voltolini succeeded in establishing an opening for a greater 
 length of time than others had been able to accomplish, by 
 the use of the galvano-cautery puncture. He found that 
 the use of this instrument was followed by less hemorrhage, 
 by cicatricial tissue that did not close the aperture as readily 
 as when other methods were used. Politzer's eyelet was 
 used as a means of retaining a permanent opening. ' The 
 eyelet is simply a small one of ivory or bone, which is placed 
 in a slit-like incision at some selected point of the membrana 
 tympani, and is allowed to remain until the tissue heals 
 about it, in a somewhat similar manner as it does about the 
 gastric canula for experimental investigation of the function 
 of the stomach. In a number of cases, however, suppurative 
 inflammation has set in ; and the eyelet in one case dropped 
 within the tympanum, and was the source of serious inflam- 
 mation before it was finally removed. The results obtained 
 by these efforts at permanent openings have been neither 
 uniform nor satisfactory. In a number of cases which have 
 come under my observation, in which the galvano-cautery 
 was used, the patients' statements were to the effect that 
 the tinnitus was greater after the operation, while the hear- 
 ing was not permanently improved. Careful examination of 
 the patients who had been under my care, and who were 
 subsequently operated upon in this manner, showed that the 
 cicatricial tissue resulting from the galvanic puncture formed 
 more extensive adhesions than previously existed. 
 
 Gruber, in 1863, introduced to the profession his operation 
 called myringodectomy. A triangular flap was cut out of 
 the membrana tympani, with a hope that a permanent open- 
 
CHRONIC CATARRHAL INFLAMMATION. ()l 
 
 ing would be maintained by the healing of the edges of the 
 wound in such a way that it would not be completely closed. 
 The operation is pronounced dangerous, both by reason of 
 excessive hemorrhage, and by the subsequent suppuration 
 which almost always followed ; and, in those cases in which 
 both of these dangers have been avoided, the operation is 
 found to bear no proportionately favorable results to iridec- 
 tomy. Weber Liel suggested a division of the tendon of the 
 tensor tympani muscle. This operation is based on good 
 physiological reasons ; for the release of the tendon of the 
 tensor tympani muscle should overcome the inward press- 
 ure upon the ossicula, thereby overcoming the pressure 
 upon the labyrinthine fluids. The results of this operation, 
 again, are not uniformly successful. Division of the posterior 
 folds is suggested by Politzer. This is open to the same 
 objections as hold regarding cicatricial tissue already men- 
 tioned. Prout has operated for the division of the adhesions 
 which exist between the membrana tympani and the ossicula, 
 or the tympanic walls. This seems the most feasible of all 
 operations, and is the only one which my experience warrants. 
 The difficulties encountered in locating adhesions, and cer- 
 tainly in determining their extent, are appreciated by one 
 who has had any extended experience in the use of Siegel's 
 otoscope, as used for the determination of this fact. 
 
 Hinton's operation of incision for the remioval of accumu- 
 lations of mucus or lymph, is a practical suggestion, and has 
 been generally accepted and practised, whereas all the others 
 have fallen into disrepute. Some years ago it occurred to me, 
 while using Siegel's otoscope for diagnosis, that it might be 
 applied as a means of treatment ; and I attached the mouth- 
 piece of the instrument to an exhausting-pump, and have 
 since used it more or less. About a year after my first use 
 of it. Dr. Howard Pinckney published an article suggesting 
 a similar use of Siegel's otoscope, using a common stomach- 
 pump as a means of exhausting the air. This treatment is 
 often productive of the cessation of subjective sounds, as 
 well as of the sensation of stuffiness or fulness in the ear. 
 
64 LECTURES ON CLINICAL OTOLOGY. 
 
 Medicinal tiratment. — The medicinal agents used for this 
 form of disease of middle ear divide into two classes, as the 
 drugs have excess of secretion, or are marked by dryness of 
 the mucous membrane in their physiological action. Promi- 
 nent among the remedies for the first form characterized by 
 thickening, hyperaemia, hyperplasma of the mucous mem- 
 brane, are baryta miiriaticay calcarea iodata, calcarea phos- 
 phorica, coniicm^ gelserniumy hepar stclph.y hydrastis, iodine, kali 
 mtmaticum, kali kydriodicnm, merciiriics, Phytolacca, pnlsatillay 
 sangninaria nitrate, tencrinm. For the opposite state of 
 atrophy, carbo veg., causticum^ cinchona, graphites, iodine, kali 
 phosphor., kali hydriodicum^ magnesia phosphorica, petroleum ^ 
 pJiosphorns, silicea. 
 
SEVENTH LECTURE. 
 
 ACUTE SUPPURATIVE INFLAMMATION OF THE MIDDLE EAR. 
 
 Gentlemen, — We will consider to-day the subject of 
 Acute Siippiiratio7i. It is to be remarked, that the acute ca- 
 tarrh thickens the tissue, whereas acute suppuration destroys 
 the tissue ; i.e., that repeated attacks of acute catarrhal in- 
 flammation, unless passing over into chronic catarrhal inflam- 
 mation, causes a proliferation and thickening of the tissues 
 of the tympanum. Acute suppurative inflammation, as 
 already marked, tends to the destruction and perforation of 
 the membrana tympani. There are apparent exceptions to 
 this in certain cases, where there is no pain, no appear- 
 ance of moisture, until suddenly pus is found flowing from 
 the ear. In the great majority of cases, however, it is true 
 that an otitis media, in the acute suppurative attack, is always 
 associated with pain, and is remotely associated with some 
 phase of naso-pharyngeal disease. These exceptional cases 
 are found in phthisical patients, or in certain cases of chronic 
 otitis externa, where there has been ulceration earlier in the 
 history of the case, which in its later stages has passed un- 
 noticed, until the membrana tympani has sloughed, and otitis 
 media has supervened ; but this is exceptional. 
 
 Symptoms. — The subjective symptoms are those of the 
 Eustachian tube : pain is caused by coughing, sneezing, or 
 any motion of the pharyngeal muscles, as by swallowing or 
 eructation ; associated with pain, fever, tinnitus aurium, loss 
 of hearing, vertigo, and, in severe cases, delirium. The ob- 
 jective symptoms are, changes of the membrana tympani, 
 
66 LECTURES ON CLINICAL OTOLOGY. 
 
 such as loss of translucency, thickness, loss of the light spot, 
 sometimes a coppery redness, moisture, or a sodden condi- 
 tion. As was said in speaking of diseases of the membrana 
 tympani, myringitis, strictly speaking, is a rare condition ; the 
 classification of the disease depending upon the preponder- 
 ance of the symptoms as regards lesion of the dermoid surface 
 of the membrane, or the internal mucous membrane. 
 
 Course. — The course is on to perforation, with relief of 
 the pain ; on to suppuration, if not treated. The products 
 of suppuration may escape by the way of the Eustachian 
 tube, in children ; and the membrana tympani may not be 
 destroyed. In adults, with unyielding membranes, the latter 
 having been thickened by repeated attacks of catarrhal in- 
 flammation, the pus may press in every direction before the 
 drum-head yields, — up to the cerebrum or cerebellum, down 
 to the jugular vein, inward to the labyrinth, posteriorly to the 
 mastoid cells, — and cau^e serious lesions in either of these 
 directions. 
 
 Under treatment, however, the tendency is to resolution, 
 even to perfect restoration. The rapidity, the completeness 
 of repair, is something very remarkable. Some careless peo- 
 ple invite suppuration, doing nothing until hearing is gone 
 beyond recovery. This is due in many cases to the popular 
 idea that suppuration is beneficial ; such a notion being sup- 
 ported by the relief that follows rupture of the membrane, 
 as well as by the serious results which have followed sup- 
 pression of the suppurative or purulent discharges, under 
 unwise treatment. The profession itself is not free from 
 blame for giving support to this erroneous view. 
 
 AitioLogy. — The same causes which produce acute catarrhal 
 disease are active in this form of disease, more especially the 
 use of 'the nasal douche, sea-bathing, scarlet-fever, measles, 
 diphtheria, and traumatic causes. While it is true that the 
 nasal douche may cause acute catarrhal inflammation, or 
 even chronic catarrhal inflammation, the careless use of this 
 instrument .has been followed, in my observation, by acute 
 suppurative .inflammation in a large number of cases. The 
 
ACUTE SUPPURATIVE INFLAMMATION: 6/ 
 
 same may be said concerning the practice of snuffing water 
 for the purpose of overcoming obstructions in the naso- 
 pharyngeal tract, as is advised by physicians not aware of 
 the danger to which they thereby expose their patients. 
 The practice of sea-bathing is open to objections for the 
 same reasons, in many cases. In a few instances, inflam- 
 mation may have been set up by the direct force of the 
 waves in surf-bathing ; but, in most cases that have come 
 under my notice, I am satisfied that the salt water reached 
 the tympanum by way of the Eustachian tube, during the 
 violent efforts to free the nose and pharynx from the water. 
 In all these instances, whether produced by the douche, by 
 snuffing, or by sea-bathing, the water acts as an irritant when 
 once within the tympanum, and the inflammatory action 
 passes very rapidly beyond the grade of simple catarrhal 
 inflammation. Scarlet-fever stands first, among the exanthe- 
 mata, as a cause of middle-ear disease ; next, measles ; and, 
 third, diphtheria. The changes which are wrought by the 
 first two, leave lifelong traces upon the naso-pharyngeal and 
 tympanic mucous membrane. Diphtheria causes, in my 
 judgment, greater changes in muscular tissue than in the 
 mucous membrane : at least, such has been my view, based 
 upon the cases which I have observed. Phlegmonous inflam- 
 mation of the tonsils, or chronic enlargement of the same, 
 may act mechanically as a cause ; but more has been said 
 and written of chronic tonsillitis as a cause of middle-ear 
 disease than the facts warrant. Traumatic injury of the 
 membrana tympani may act as a cause of acute suppurative 
 inflammation. If promptly and intelligently cared for, such 
 need seldom be the case. Dentition, especially in children, 
 has been shown to bear a direct relation to trophic changes 
 in the tympanum. The same is true in adults ; though usu- 
 ally, with the latter, the form of disease will be otalgia neu- 
 ralgica, rather than otitis. Authorities are now agreed that 
 there exists a relation between the dental branches of the 
 trifacial and the tympanic nerves. 
 
 Dr. Woakes, particularly, has given his experience in con- 
 
6S LECTURES ON CLINICAL OTOLOGY. 
 
 firmation of this view ; and I take pleasure in referring you 
 to his little work, for a full discussion of this subject. 
 
 Diagnosis. — The differentiation between otalgia neuralgica 
 and colic, in children, is, perhaps, the most important point 
 for you to observe. What has been said with regard to 
 suppuration without pain, will lead you to examine patients 
 carefully as regards phthisical tendencies ; and the same may 
 be said as to the examination of the teeth, to distinguish 
 between otitis and otalgia. In otitis, the bulging, and evi- 
 dences of congestion, will be associated with decided loss of 
 hearing ; whereas your neuralgic patient will be able to hear 
 normally, unless the case be complicated by middle-ear dis- 
 ease. The angular explorer, used by dentists, should be 
 found in your armamentarium, and will be of great service in 
 the examination of the crowns of the teeth. 
 
 Prognosis. — The prognosis of acute suppurative inflam- 
 mation is favorable under the methods of treatment now in 
 use, but certainly unfavorable if neglected ; as its tendency 
 is to the destruction of tissue, and the establishment of a 
 chronic suppurative condition. 
 
 Treatment. — The same mechanical treatment which was 
 suggested in acute catarrhal inflammation, is of value in this 
 form of disease. The application of vapor of water, or of 
 hot water to which has been added a few drops of aeonite, 
 belladonna, or plantago tincture, dropped into the meatus as 
 hot as can be tolerated, will not only mitigate the pain, but 
 help to abort the disease. If the inflammatory action is not 
 relieved by medication, and if the membrana tympani threat- 
 ens to rupture spontaneously, paracentesis will not only re- 
 lieve the suffering, but leave the tissues in a condition more 
 favorable for repair than will be the case if spontaneous 
 rupture be allowed to take place. Any knife similar to a 
 tenotomy knife may be used in an extremity ; but either of 
 the forms which have been suggested by Roosa, Knapp, or 
 Agnew is to be preferred. The lance-shaped paracentesis 
 knife ' will be sufficient to penetrate the membrane ; but a 
 
 ^ See cuts on p. 22. 
 
ACUTE SUPPURATIVE INFLAMMATION. 69 
 
 knife formed more like a curved bistoury is better adapted, 
 if it is desirable to make a larger incision from the point of 
 penetrating to the periphery. Even a needle, securely fas- 
 tened in a wooden handle, and guarded within a millimetre 
 of its point by cotton wound firmly upon it, will serve to 
 penetrate the membrane, and relieve the cavity of the tym- 
 panum of the accumulated gaseous or fluid contents ; and it 
 is astonishing what relief this simple proceeding will give. 
 The fact that a small opening closes very promptly, will 
 necessitate, in most cases, a larger incision ; and it is good 
 practice to follow paracentesis by inflation of the middle ear, 
 using Politzer's method or a catheter, as may seem best. 
 Suction applied to the meatus, by the use of Siegel's oto- 
 scope, has proved of practical value, drawing the contents of 
 the tympanum through the perforation, or bringing thick 
 mucus through the perforation, so that it can be seized by 
 forceps, and drawn out entirely. 
 
 In the transactions of the American Homoeopathic Oph- 
 thalmological and Otological Society for 1884, W. H. Winslow, 
 M.D., of Pittsburg, Penn., reports a case in which he used 
 Siegel's otoscope in an original manner. Acute inflammation 
 of the middle ear had advanced to such a degree that the brain 
 was slightly involved : incision of the membrane followed by 
 inflation afforded but little relief. Strong suction with Sie- 
 gel's otoscope caused a flow of bloody serum with immediate 
 relief ; and, later, the products of suppuration were removed 
 in a similar manner. The patient made a complete recovery. 
 
 Remedies. — Aco7nte, belladonna^ cJianiomilla^ capsicum, dul- 
 camara, gelseniium, and tellurium. Aconite is indicated in 
 high fever, burning skin, great restlessness and thirst. Bel- 
 ladonna, less marked redness and heat of surface, less rest- 
 lessness, but mentally a desire to escape. Chamomilla is 
 characterized by the same intolerance of pain on the part of 
 adults, or extreme irritability and peevishness of children. 
 Capsiciun is of value for adults when the mastoid process is 
 threatened by the inflammatory action. Dulcamara and 
 gelsemium are of more value in acting against threatening 
 
JO LECTURES ON CLINICAL OTOLOGY. 
 
 suppuration than when it is fully established. The same 
 symptoms would indicate hepar sidpJi. calcarea^ as those men- 
 tioned in acute catarrhal inflammation, — the local tender- 
 ness about the ear, especially in front and behind the auricle, 
 sensitiveness about the ear, and relief by wrapping. Merat- 
 7'iiLs has the same symptoms as under catarrhal inflammation, 
 but more marked. Pulsatilla is especially valuable in the 
 earlier stages of the disease, especially in children. Tellu- 
 rium is indicated in cases where perforation has occurred 
 spontaneously, or where the tendency is to rupture, and to 
 extensive destruction of the tissue ; the discharge being of an 
 ichorous, excoriating, and especially fetid nature, smelling 
 like fish-pickle. An intercurrent dose of szilphiir ox psorimnn 
 will prove valuable in bringing out more clearly the distinc- 
 tive indications for the previously mentioned remedies. 
 Electricity has proved not only a mitigating agent in the 
 treatment of acute suppurative inflammation of the middle 
 ear, but I am satisfied it has cut short the history of the dis- 
 ease. The same principles underlie its application that have 
 been demonstrated in the treatment of paronychia, — felori. 
 On application of the positive pole to the meatus, covered 
 with sponge or cloth dipped in hot water ; and the negative 
 pole to the feet, by means of a hot bath, — and allowing the 
 passage of the current for the space of three to five minutes, 
 great relief is afforded. 
 
 This has been true of both the galvanic and the faradic 
 currents, and is commended to those who by experience are 
 qualified to apply this means of relief ; as in unskilled hands 
 it is an agent of destruction instead of reparation. 
 
EIGHTH LECTURE. 
 
 CHRONIC SUPPURATIVE INFLAMMATION OF THE MIDDLE EAR. 
 
 Gentlemen, — -The remote causes of this disease are the 
 same as, and coincident with, those of acute suppuration ; 
 and you will remember, that, in speaking of that disease, I 
 told you that its history, unchecked by treatment, passed on 
 into that of chronic suppurative inflammation. It is also 
 true, that, in a limited number of cases, otitis externa, causing 
 ulceration of the membrana tympani, involves the substantia 
 propria ; and, finally, the mucous membrane of the tympanic 
 cavity gives way. Then there is set up a chronic suppura- 
 tive inflammation, which does not differ in its symptoms, or 
 subsequent history, from one which arises in the tympanum 
 itself. 
 
 Symptoms. — The two leading symptoms are the discharges 
 and the deafness. x-\llow me to call your attention to a term 
 found very frequently in our literature, which is used to des- 
 ignate a disease, — otorrhoea. This is the name, not of a 
 disease, but simply of a symptom of a disease. The make- 
 up of the word, as you understand, indicates its meaning, — 
 '* a flow from the ear," — and is no more the name of a disease 
 than is leucorrhoea, which is simply the name of a flow from 
 the vaginal or uterine mucous membrane, or from both. I 
 trust, that in your writings, — as it may be presumed that you 
 will be writers, — you will correct this error. As regards the 
 nature of this discharge, it may be said that it is marked by 
 all the shades of difference between pure pus and a muco- 
 purulent discharge which is more mucous than pus. The 
 
 V- 
 
72 LECTURES ON CLINICAL OTOLOGY. 
 
 purulent discharge may also be laudable, bland, or ichorous, 
 excoriating, sanguineous ; and on these small points of differ- 
 ence is based the prescription of various remedies. The 
 deafness is in marked contrast to that in many cases of 
 chronic catarrhal inflammation. And here I wish to men- 
 tion another error, from which, even to-day, the profession 
 is not altogether free. It is not long since I had occasion to 
 comfort a patient, who had been thrown in a state of great 
 alarm and anxiety by being told by a female physician of some 
 eminence in this city, that the drum-head was destroyed, 
 and hence her hearing was forever gone. This was a serious 
 mistake, as it might have led her to abandon all treatment. 
 The fact which I have noted, of the possibility of greater 
 hearing-power in suppurative than in chronic catarrhal in- 
 flammation, will be clear, when you remember the anatomi- 
 cal relations and lesions of chronic catarrhal inflammation. 
 The fact of adhesions and pseudo-anchylosis is a much more 
 serious one, so far as hearing-power is concerned, than ar- 
 ticulations bathed in pus, or muco-purulent secretions. So, 
 too, when these secretions are overcome, a great amount of 
 power can be promised by artificial means, as we shall see 
 when studying the adjustment of the artificial membrana 
 tympani or the cotton pellet. There are certain facts touch- 
 ing the calibre and length of the canal, the appearance of 
 the membrana tympani, and of the mucous membrane of the 
 cavity of the tympanum, if the drum-head be perforated, 
 which will, as objective symptoms, help you to distinguish 
 between otitis externa and otitis media. Until the eye is 
 educated, you may not be able to determine whether the 
 granulation, ulceration, pus, or mucus, which is seen, is lo- 
 cated in the canal, upon its walls, or upon the walls of the 
 cavity of the tympanum. Indeed, even an educated eye is 
 sometimes under the necessity of employing all the helps 
 which may be brought to bear. Practice, however, will en- 
 able you to distinguish the remaining portions of the mem- 
 brana tympani, if largely destroyed, and will also gradually 
 take in the perspective of greater or less depths of the canal 
 and tympanic cavity. 
 
CHRONIC SUPPURATIVE INFLAMMATION. 73 
 
 Histoiy. — This is usually one of neglect ; and I cannot 
 too strongly deprecate the assurance which is given, not only 
 by friends, but by medical advisers, that time will overcome 
 this disease. In fact, the advice which is given by elders to 
 children, and to inexperienced patients, is based upon, and 
 supported by, the advice of the faculty from time imme- 
 morial : only within the last few years has there been any 
 thing like an intelligent understanding of the causes of 
 otitis and the reasons why this form of disease leads to fatal 
 results. 
 
 Prognosis. — As is intimated by what I have already said, 
 the prognosis is unfavorable if the disease is allowed to take 
 its course. It is certainly favorable under the best instru- 
 mental and medical treatment of to-day. I may state here, 
 — not in any spirit of egotism, but to emphasize an important 
 truth, — that, for more than seventeen years, I can review 
 the history of cases, and assert, that where the parents, 
 guardians, or others having the charge of patients, have per- 
 sisted in maintaining the treatment year after year, in no 
 instance have I failed to reach the desired result. In two 
 cases, children who had suffered from scarlet-fever, barely 
 escaping with their lives, both membranae tympanorum lost, 
 the suppurative process has been brought to an end ; and, 
 by the use of a cotton pellet, these children, now young 
 ladies, are able, with but little difficulty, to understand all 
 ordinary conversation. In one case, however, it required 
 nine years, and in the other, eight, to reach this much-desired 
 issue. 
 
 Treatment.' — The local treatment is as important as the 
 selection of proper remedies, and I may here repeat what I 
 have previously stated. I do not believe that local treatment 
 in any sense interferes with constitutional, general treat- 
 ment, but, on the other hand, renders the medicinal treat- 
 ment more prompt, more successful. I believe, that as in 
 moral matters, so here, ''cleanliness is next to godliness." 
 By the use of what is called the "dry treatment," and the 
 application of remedies in triturations, using an insufflator 
 
74 
 
 LECTURES ON CLINICAL OTOLOGY. 
 
 similar to that used in the larynx, the excessive purulent 
 or muco-purulent secretion of the mucous membrane may 
 be gradually modified, until it becomes normal, in no sense 
 suppressed, or giving rise to any thing suggestive of me- 
 tastasis : on the other hand, you guard 
 against the consequences of destructive 
 processes, which must, in time, reach 
 deeper structures, and bring a fatal result. 
 I have used sulphate of zinc, bichromate of 
 potash, salicylic acid, borax, boracic acid, 
 alunicn ttstum, calcarca phosphorica, calen- 
 dula, nitrate of sanguinaria, and other 
 remedies, in the first and second tritura- 
 tions, with excellent results ; and in no 
 case have I seen unfavorable — immediate 
 or remote — results. In some instances, 
 simple drying of the mucous membrane 
 with pledgets of cotton — removing every 
 trace of the secretion — has been sufficient 
 to stop the secretion; but in longstanding, 
 neglected cases, I have resorted to the trit- 
 urations. You will understand, that in no 
 case is the local treatment to be pursued 
 to the neglect of more important constitu- 
 tional treatment. Concerning the much- 
 mooted question as to the use of the syr- 
 inge, I have simply to say, that, for a num- 
 ber of years, I have abandoned its use, 
 save for the removal of foreign bodies, or 
 masses of dry or softened detritus, in the 
 canal or the cavity of the tympanum. When using it, either 
 in clinical or private practice, I follow its use with the ab- 
 sorbent cotton, drying every portion of the exposed mucous 
 membrane as perfectly as possible. I am satisfied that more 
 mischief is likely to follow its abuse than its entire prohibi- 
 tion, in the hands of the laity ; and therefore I direct parents, 
 or persons in charge of the case, to dry the ear as perfectly 
 
 Powder-Blower. 
 
CHROXIC SUPPURATIVE IXFLAMMATIOX. 75 
 
 as possible by the use of absorbent cotton, supplementing 
 their work with my personal attention. In many cases, the 
 presence of granulations or polypi will require instrumental 
 interference. If polypoid growths obstruct the canal, threat- 
 ening the retention of the secretions, they should be removed 
 by the snare or looped curette, rather than by torsion. If 
 retention of pus is not threatened, the instillation of alcohol, 
 or the application of equal parts of alcohol and saturated 
 solution of boracic acid, will cause the growth to shrivel, and 
 prepare for its easy and painless removal. Its return, how- 
 ever, must be prevented by internal remedies : and the same 
 may be said of excessive granulations ; these may be removed 
 by Wolfe's sharp spoon, or by the saturated solution of bi- 
 chromate of potash, as suggested by Dr. William P. Fowler 
 of Rochester. They usually return, unless combated by 
 indicated internal treatment. But much is secured in the 
 direction of complete symptomology by study of the local 
 indications of a constitutional dyscrasia. As a means of 
 overcoming the unavoidable exposure of the mucous mem- 
 brane of the cavity of the tympanum, when the membrana 
 tympani has been, to a greater or less extent, destroved, 
 various devices have been proposed. The first of these 
 was suggested to Dr. Yearsley, an English surgeon, by a 
 patient, who demonstrated to him that he could increase 
 his hearing-power very largely, by the introduction of a roll 
 of paper, which, on touching a certain spot, — which the 
 patient could determine by careful manipulation, — increased 
 the hearing-power so that he could understand conversation 
 — in fact, every sound — with great facility. This led Dr. 
 Yearsley to experiment with balls, or rolls, of cotton ; and 
 he demonstrated, that, in a very large ^ 
 
 number of cases, they acted as a sup- Q* — . ■. ^-, 
 
 port to the ossicula. This led to the \j 
 
 introduction of the artificial membra- tovnbee's artificial membrana 
 
 iVMPANI. 
 
 na tympani by Dr. Toynbee, which 
 
 consists of a thin disk of rubber, mounted on a silver stem, 
 
 sufficiently long to reach from the remains of the membrana 
 
^6 LECTURES ON CLINICAL OTOLOGY. 
 
 tympani, to the orifice of the meatus. I have found it of 
 most service in those cases in which the remains of the 
 drum-head were covered with a bland secretion, more mucoid 
 than purulent. In very many cases it acts as an irritant, 
 and therefore is not tolerated by the patient. In cases of 
 small perforations, Dr. J. Clarence Blake has suggested the 
 use of disks of sized paper. These, adjusted over the per- 
 forations, not only close them, and improve the hearing, but 
 have been the means of promoting cicatricial closure of the 
 perforations. The same is true of the cotton pellet, which 
 in recent years has come prominently before the profession 
 as a substitute for the artificial membrana tympani, and 
 proved to be very valuable in a large number of cases. What 
 is effected by the paper disk is secured by the use of the 
 pellet : it not only protects the perforation, guarding the 
 mucous membrane from the external air, but it serves also 
 to hasten the closure of the perforation. And here I may 
 caution you against the careless removal of crusts which 
 may cover recent perforations ; as I am certain that I have 
 retarded the closure of perforations, by too hasty removal of 
 those secretions which nature had thrown out during the 
 formation of cicatricial tissue. The absorbent cotton, rolled 
 loosely between the fingers, and moistened with concentrated 
 petroleum, or even applied without it, is better than cotton 
 saturated with glycerine, as has been suggested by some 
 writers. The petroleum is tolerated ; while the glycerine 
 causes a discharge of a lymphy or purulent nature, which is 
 the very thing we desire to overcome. This roll of cotton 
 should be applied so as to support the remams of the manu- 
 brium of the malleus, when the perforation is large, or simply 
 to cover the perforation itself if it be small. The following 
 cases illustrate the use of the cotton pellet. 
 
 Patients who have themselves made attempts at cleansing 
 the cavity of the tympanum, have at times experienced a 
 loss of sensation and taste on one-half of the tongue, and 
 have been seriously alarmed at the results so produced. You 
 will understand how this has been caused, when you consider 
 
CHRONIC SUPPURATIVE INFLAMMATION. TJ 
 
 the relation of the chorda tympani nerve to the branch of 
 the facial, which passes through the upper portion of the 
 tympanum. In cleansing the cavity, the surgeon may pro- 
 duce this symptom ; but it is usually of short duration, and 
 need cause no special alarm. Vertigo may be produced in 
 the same manner, or by the forcible use of the syringe. This 
 is due to direct pressure, either upon the disarticulated stapes 
 or the exposed fenestra rotunda, thereby causing change of 
 the tension of the labyrinthine fluids. This is not usually a 
 serious symptom : but you must not allow this fact to make 
 you unmindful of persistent vertigo, associated with suppu- 
 rative disease of the middle ear ; as we shall see that it is 
 one of the symptoms of necrosis, or caries of the labyrinth. 
 
 Remedies. — The indications for the remedies will be found 
 very largely pointed out, by studying the conditions of the 
 naso-pharynx and the Eustachian tube, as well as by consid- 
 ering the objective symptoms which present themselves in 
 the meatus externus. Calcm^ea pJios, is of great importance 
 in scrofulous patients with enlarged tonsils and a tendency 
 to grossness of tissue, or to involution of the periosteum, 
 and cancelled tissue of the temporal bone. You have no- 
 ticed, undoubtedly, that it is frequently prescribed for the 
 poorly nourished children who present themselves at the 
 chnic, those with large heads, large bones, and flabby tissues 
 generally. Cinchona has proved of more value in our hands, 
 in cases of hemorrhage from the mucous membrane of the 
 middle ear, than has any remedy laid down in our reperto- 
 ries. This is a matter of clinical experience, rather than 
 pathogenetic knowledge. After having used the various 
 remedies, cicnta, kamamelis, elaps, and pJwspJiortis, and 
 failing of satisfactory results in a particular case, I gave 
 cincJwna off., in a low potency, on general principles, for the 
 anaemic condition of the patient. To my great satisfaction, 
 the patient's condition not only improved, but the hemor- 
 rhage from the ear ceased ; and, from the exhibition of this 
 remedy, an improved condition of the tissues began, which 
 was carried to a successful issue by the administration of 
 
y8 LECTURES ON CLINICAL OTOLOGY. 
 
 Other remedies. This I believe to be the scope of cinchona, 
 and I use it intercurrent with calcarea pkos., kali miiriati- 
 cinn, inerciu'iuSy psoriimm, silicca, siUpJiur, tellurium, or tJiuya. 
 Elaps is a valuable remedy in the case of children : the 
 naso-pharynx is characterized by dryness of secretion ; the 
 mucous membrane of the posterior wall of the pharynx 
 cracks, or is covered with dry crusts ; the nares are obstruct- 
 ed, crusty, so that the child has what the old nurse calls 
 "snuffles," and, when sleeping, breathes with the mouth 
 open. The discharge from the ear is thin, somewhat irritat- 
 ing, staining the bedclothes on which it chances to fall, a 
 clear green color. Hepar sulpJi. calcarea is especially indi- 
 cated in ulcerations, perforations, the particular indications 
 being sensitiveness of the tissues. Hydrastis canadensis is 
 indicated by a bland discharge, which is more mucus than 
 pus, associated with dropping, in the posterior nares, of a 
 yellowish catarrhal secretion. Kali bichrom, is analogous to 
 Hydrastis, has the muco-purulent nature of the secretion, 
 but the tissues are more irritable, tending to bleeding or to 
 crusts ; and the naso-pharyngeal tract manifests the same 
 disposition. Kali viuriatictnn, introduced by Sch ussier, is, in 
 my judgment, a good remedy for excessive granulations ; and 
 I have had more satisfaction from its use than from any other 
 single remedy. In repeatedly occurring granulations on the 
 inner third of the canal, about the edges of the perforations, 
 or on the tympanic wall, I always expect improvement under 
 this remedy, in conjunction with the local treatment which I 
 have already laid down. Kali hydriod. in saturated solution 
 is of value when there is a certainly recognized syphilitic 
 dyscrasia underlying the local ulceration. Mercurius sol. has 
 proved, in clinical experience, to be indicated by this charac- 
 teristic, — a coppery or metallic odor of the secretion, as well 
 as by the well-known naso-pharyngeal symptoms. Psorinuni 
 has an extremely fetid discharge, associated with eczematous 
 conditions about the ear, or in other parts of the body. You 
 will compare it with tellurium and thuya. Sulphur is a 
 valuable intercurrent remedy, and may be used when other 
 
CHRONIC SUPPURATIVE INFLAMMATION. 79 
 
 remedies apparently fail to overcome the conditions for which 
 they are clearly indicated ; and its administration often serves 
 to bring out, and render clear, conditions which were before 
 obscure. The general symptoms of the integument should 
 be noted carefully, to guide in the administration of this 
 remedy. Tellurium is indicated for conditions of the drum- 
 head similar to phlyctaenular conjunctivitis; the whole 
 drum-head appearing dark purple, with elevated spots at 
 various points, which form vesicles, break, oozing a watery 
 discharge, having the odor of fish-pickle, extremely acrid, 
 excoriating the canal, and often the cheek. 
 
 The late Professor Carroll Dunham, M.D., made an heroic 
 proving of this remedy, and called my attention to this effect 
 on his own person, some years afterwards. Inspection of the 
 drum-head showed it to have been perforated, and afterwards 
 repaired, the cicatricial tissue being quite extensive. This 
 would argue that the remedy had much deeper action than 
 merely upon the external surface of the drum-head. In fact, 
 this has so proven in long-standing cases, particularly in 
 children. 
 
 Thuya is in decided contrast to other remedies mentioned, 
 in that its discharge is bland, thick, the odor being that of 
 putrid meat. 
 
NINTH LECTURE. 
 
 CONSEQUENCES OF CHRONIC SUPPURATIVE INFLAMMATION OF 
 THE MIDDLE EAR. 
 
 Gentlemen, — You will recollect the statement I made in 
 the introductory lecture, while impressing upon your minds 
 the serious consequences of diseases of the ear. This we 
 shall consider under our present lecture on Chronic Suppura- 
 tive Inflammation of the Middle Ear. 
 
 The tendency is to the destruction of the deeper struc- 
 tures. This fact has been noticed by life-insurance com- 
 panies, so that they have refused to take risks on persons 
 who have been for years subject to a purulent discharge 
 from the ear. The consequences of chronic suppuration are 
 classified by Roosa as follows : — 
 I. Cicatrices and adhesions. 
 II. Polypi. 
 
 III. Exostoses. 
 
 IV. Mastoid Disease. 
 
 V. Caries and Necrosis of Temporal. 
 VI. Cerebral Abscess. 
 VII. Pyaemia. 
 VIII. Paralysis. 
 
 The dry condition which exists after cessation of a chronic 
 suppuration, is of less serious nature than that which pre- 
 ceded it, even if the hearing be less : better the cicatrices 
 and adhesions, which lessen the hearing, than a suppurative 
 condition, which threatens the life. 
 
 Polypns. — This is a term growing out of the old nomen- 
 80 
 
CHRONIC SUPPURATIVE INFLAMMATION. 8 1 
 
 clature, when the nature of the structure was not under- 
 stood ; but it has become so fixed in the literature of the 
 subject, that it is impossible to eliminate it by the substitu- 
 tion of any other term. Studener classifies polypus as 
 follows : — 
 
 I. Mucus polypi — Cellular. 
 II. Fibromata. 
 
 III. Myxomata. 
 
 IV. Angioma (Buck). 
 
 Polypi are composed of connective tissue holding cellular 
 elements and blood-vessels, and are covered by epithelium. 
 Angioma is a purely vascular structure. Malignant growths 
 arising in this region are epithelial carcinoma or osteo-sar- 
 coma starting from the bone. 
 
 Treatment. — It is absolutely necessary that there be free 
 exit from the tympanum, for the products of suppurative 
 inflammation : if polypi threaten closure of the meatus, they 
 must be removed by the snare or torsion. The snare is to 
 be preferred ; as torsion involves more tissue, and is liable 
 to do mischief. Blake's modification of Wilde's snare is used 
 
 Blake's Wilde's Snare. 
 
 for the purpose. I show you here the modified instrument 
 with paracentesis knife, which can be substituted for the 
 canula. Any portion of the pedicle which remains should 
 be touched with saturated solution of kali bichromicum. 
 Dr. W. P. Fowler of Rochester, a graduate of this college 
 some years since, suggests the use of a saturated solution of 
 bichromate of potash in water ; and I know of no safer agent 
 for the purpose. Some months since, having occasion to use 
 bichromate, and not having the solution at hand, I used the 
 red acid solution as prepared for galvanic batteries : this is 
 composed of crystals of bichromate dissolved in sulphuric 
 
82 LECTURES ON CLINICAL OTOLOGY. 
 
 acid and water, as usually given in the formula with the car- 
 bon and zinc elements. Great care must be used in apply- 
 ing this in excess. All the solution should be pressed out 
 from the cotton with which it is applied, and the tissues 
 carefully dried after its application. 
 
 Exostoses. — These are bony growths arising from perios- 
 teum, and threaten by their growth to close the external 
 meatus : the tissues overlying them should be cut through, 
 and the growth beneath it should be reduced by the use of 
 a burr or chisel. The burr to the dental engine in general 
 use, is to be preferred to the chisel. 
 
 Mastoid disease. — It is necessary to observe the distinc- 
 tion between the external periostitis, inflamed glands, and 
 congestion and inflammation of the internal periosteum or 
 mucous lining of the antrum. Dr. Burnett reports a num- 
 ber of cases of mastoid inflammation which were evidently 
 external, primarily ; and the condition came to involve the 
 antrum in their later history. These are easily distinguished 
 from those beginning with congestion of the antrum, from 
 the fact that the hearing is not seriously involved, as is the 
 case when the disease is secondary to that of the tympanum. 
 The sensitive lymphatic glands may be recognized, as they 
 are localized, and the surrounding tissue is not sensitive as 
 in external periostitis : internal congestion of the antrum, 
 secondary to otitis media, may occur in acute otitis ; in fact, 
 we believe that in nearly all cases of acute disease, the lining 
 of the antrum is more or less involved. A writer in the 
 ''Practitioner" reports two classes of acute necrosis of the 
 mastoid complicating otitis media acuta. In these cases, a 
 very brief space of time sufficed to soften the tissues to such 
 a degree that the petrous portion of the temporal bone was 
 laid open with a scalpel, cutting like wet leather. The 
 relief felt by the washing and drainage was immediate ; and 
 so perfect was the repair, that six months afterward the bone 
 was as stony as ever. In chronic suppuration of the middle 
 ear, the conditions are such that we are liable at any time 
 to an involution of the mastoid region. 
 
CHRONIC SUPPURATIVE INFLAMMATION. 83 
 
 Symptoms. — The local symptoms are redness and swell- 
 ing of the mastoid process, associated with an increased flow 
 of pus from the meatus, possibly in some cases an entire 
 suppression of the discharge. There is a marked constitu- 
 tional disturbance, rise of temperature, increase of pulse ; 
 and a marked anxiety, or haggard expression, has character- 
 ized the cases which came under my notice. 
 
 The history is usually a brief one, from the fact that unless 
 relief is afforded a fatal result usually follows. 
 
 Treatment. — Perforation of the mastoid antrum. The op- 
 eration is an old one : according to the statement of Roosa, 
 it was made by Jasser in 1776, and by others at various 
 dates. Since then it has fallen into disrepute. Dr. A. B. 
 Crosby made an operation three times with a gimlet, the 
 first being as early as 1864: his three patients recovered. 
 
 Heavy Knife for Mastoid Incisions. 
 
 Schwartze's articles served to call renewed attention to the 
 subject, and the operation has been more generally made 
 since that time. Roosa lays down the following rules for 
 the operation : — 
 
 ^' Fii'st, The integument and periosteum of mastoid pro- 
 cess should be freely divided in all cases when there is great 
 pain, tenderness, and swelling in this part. 
 
 *' Second, Such an incision should also be made whenever 
 severe pain, referred to the middle ear, constantly exists, and 
 which is not temporarily relieved by the use of leeches and 
 the warm douche, etc. 
 
 ** TJiird, The bone should be thoroughly examined by the 
 aid of such an incision whenever we have good ground for 
 suspecting that the bone is diseased, or pus retained in this 
 part. 
 
 ''Fourth, The mastoid process should be perforated after 
 such an incision, whenever the bone is softened ,- or, if a 
 
84 
 
 LECTURES ON CLINICAL OTOLOGY. 
 
 fistulous opening is discovered, this should be enlarged. It 
 should also be perforated when the suppuration of the middle 
 ear involves the mastoid cells or antrum to such an extent 
 that thorough drainage cannot be secured through the mem- 
 brana tympani or external auditory canal." 
 
 In making the operation, Schwartze uses chisels ; and, a 
 free incision having been made down to the bone, he cuts 
 
 Buck's Drilis. 
 
 a small opening to the antrum, enlarging it with gouges until 
 the free opening is secured. Buck's method consists in the 
 use of drills of different sizes to effect the entrance, — one of 
 which is conical-shaped, to enlarge the opening. The point 
 selected for placing the instrument, should be a quarter of 
 an inch back of the external meatus, and on a plane below 
 the level of the upper wall of the canal. A free opening 
 must be maintained by the use of a tent, and the antrum 
 and the middle ear thoroughly washed and drained, that free 
 exit be afforded to all tracts of suppuration. In cases where 
 
CHRONIC SUPFURATIVE INFLAMMATJOX. 
 
 85 
 
 there has been suppression of the discharge from the audi- 
 tory canal, previous to the operation, I have noticed that the 
 discharge was re-estabhshed sometimes in a fevi^ hours after 
 the mastoid antrum was opened. It is undoubtedly true that 
 the engorgement of the deeper portions was relieved by the 
 incision. 
 
 Caries of the cranial bones is a more serious matter than in 
 other parts of the osseous system ; for Markoe shows that 
 
 Diagram of Mastoid Cells and Tympanic Cautv. 
 
 The inner wall of the caviiy is exposed to view, with the round and oval windows and the promon- 
 tory. M. Mastoid cells. J. Jugular fossa. E. Eustachian tube. B. Base of brain. (A. L. 
 Ranney, from Roosa's Treatise.) 
 
 exfoliation of portions of diseased bone is more rare : hence 
 the entire bone is liable to extensive disease. This is true 
 of the temporal, and accounts for the serious results of 
 lesions of the tympanum. The inner wall of the tympanum, 
 its floor and its roof, are very liable to caries : the promon- 
 tory, being more exposed, may be involved very early in the 
 disease ; hence the comparatively frequent exfoliation of 
 the cochlea, or the vestibule and semicircular canals. If the 
 ulceration of the floor of the cavity result in death of the 
 periosteum, caries may expose the Fallopian canal, and cause 
 paralysis of the facial nerve, either from pressure or neuritis : 
 if from pressure, there is a possibility of recovery ; as the 
 pressure is resumed by absorption. One case under my care 
 
86 • LECTURES ON CLINICAL OTOLOGY, 
 
 has recovered under internal remedies and the induced cur- 
 rent. Caries of the squamous portion of the temporal may 
 prove a serious matter : if its thin tables yield to the advan- 
 cing inflammation, the periosteum of the internal table being 
 dura mater, a meningitis follows as the necessary conse- 
 quence. 
 
 Cerebral abscess. — Meningitis in acute necrosis may cause 
 extensive effusion, and death be preceded by coma and con- 
 vulsion. In caries the process is a less rapid one : the mo- 
 lecular death may cause extensive destruction of the dura 
 mater ; hence suppuration results, the cerebral tissue breaks 
 down, and abscess is the exciting cause of paralysis of some 
 nerve-function before death of the patient. 
 
 Phlebitis is another possible complication of caries of the 
 walls of the tympanum. The literature of mastoid disease 
 contains reports of undoubted extension of the disease to 
 the lesser veins, and even to the lateral sinus. The symp- 
 toms are such as are present in inflammation of the veins 
 elsewhere in the body, — induration of the tissues of the 
 neck, involving the direction of the sterno-cleido-mastoideus, 
 and yielding to treatment only as the mastoid disease lessens 
 in force. It may give rise to the more serious condition of 
 pyaemia. 
 
 Pycemia. — By the introduction of pus into the circulation, 
 a systemic poisoning of the blood results : there is a sudden 
 rise of temperature, increase of pulse, chills, and a marked 
 distress manifested in the countenance of the sufferer. Mul- 
 tiple abscesses may result from the septic condition, or local- 
 ized inflammation of the veins, pneumonia, hepatic abscess, 
 etc., constituting one of the gravest complications possible. 
 
 Paralysis. — Failure of the facial nerve has been mentioned 
 as a result of necrosis, or caries of the floor of the tympa- 
 num ; but lesion of the brain may result in paralysis of one 
 side of the body, and not cause death. Indeed, the possibil- 
 ities of the explanation of some forms of nervous disease, 
 by the study of co-existing aural disease, is mentioned by 
 recent writers. 
 
CHRONIC SUPPURATIVE INFLAMMATION. ^J 
 
 Hemorrhage. — Ulceration of the walls of blood-vessels 
 lying, for a portion of their course, in immediate relations 
 with the osseous structure of the temporal, may cause escape 
 of either venous or arterial blood ; if the vessels are small, 
 and pressure can be exerted upon them, no concern need be 
 felt : but death has occurred from sudden and uncontrollable 
 hemorrhage. 
 
 Remedies. — I am satisfied that remedies do control, not 
 only the primary conditions, which lie remotely at the foun- 
 dation of the suppurative process, which terminates in caries, 
 but that we may expect repair of the bony structures. This 
 takes place under the continued use of remedies known to 
 modify the repair of bone in other parts of the osseous frame- 
 work of the body. No possible reason can be advanced why 
 this bone should be the one exception to the recognized 
 action of such remedies. Belladonna^ ferrnni pJios., gelse- 
 iniinn, exercise control over the arterial supply, here as well 
 as elsewhere in the economy. Hepar sidph. calearea, silicca, 
 calcarea flnorica, Hecla lava, act upon these tissues to check 
 destruction, as wxll as to hasten their repair. Capsicznn an- 
 nunm would be scarcely thought to have any control over 
 mastoid inflammation, were it not that clinical experience 
 has confirmed the physiological indications laid down in the 
 proving. 
 
TENTH LECTURE. 
 
 UNUSUAL DISEASES OF THE MIDDLE EAR. 
 
 There are some conditions which do not necessarily be- 
 long to any division of this classification, of which I will 
 speak at this time. In connection with many cases of what 
 I have termed the post-catarrhal form of chronic catarrhal 
 inflammation, there is a functional condition, which has, as 
 its characteristic feature, sounds which are undoubtedly pro- 
 duced by spasmodic action of the tympanic muscles. These 
 may be snapping, as of the nails of one's fingers, or like the 
 flapping of a bird's wings before the ear. Sometimes these 
 sounds are described as being in the head rather than in the 
 ear. On one occasion, at the annual meeting of the " State 
 Medical Society " of this State, a case of this kind was re- 
 ported. In some remarks made by the late John F. Gray, 
 M.D., he spoke of a case in which the subject believed these 
 sounds to be produced by spirits, or at least to be connected 
 with manifestations of so-called modern spiritualism. Dr. 
 Gray stated that he was able to convince the patient that 
 this was not the case, by producing similar sounds in his own 
 person at will. This provoked some merriment ; and, in 
 remarks made in support of the doctor's claim, I said I saw 
 no reason why the will-power could not be brought to bear 
 to reproduce these sounds, as we know that there are both 
 voluntary and involuntary nerve-supply to the tympanic 
 muscles. I was invited by Dr. Gray to visit him at his own 
 oflice, on our return to the city ; and I did so within a few 
 days, when he demonstrated to my satisfaction his power to 
 
UNUSUAL DISEASES OF MIDDLE EAR. 89 
 
 produce at will the snapping sounds, which are characteristic 
 of the spasms of the tympanic muscles. On placing my ear 
 immediately to his own, sounds similar to that of snapping 
 one's nails were repeatedly recognized ; and he could produce 
 them on either the left or the right side. Careful inspection 
 of the drum-head did not demonstrate any motion of the 
 same. I regret that I did not use a manometer, to demon- 
 strate any slight motion w^hich could not be recognized by 
 the eye. These functional disturbances of the muscles are 
 similar to those that occur in the muscles of the eye. 
 
 Certain organic changes that are unusual should be noted. 
 The presence of blood in the cavity of the tympanum, which 
 is undoubtedly due to the giving way of minute vessels of the 
 mucous membrane, called by Professor Roosa, ''otitis media 
 hemorrhagic," is believed to be associated more particularly 
 with Bright's disease. Of tubercular degeneration I have 
 spoken in connection with acute suppurative disease without 
 pain. Desquamative disease of the mucous membrane lining 
 the tympanic cavity of the mastoid cells may occur with an 
 imperforate drum-head, but has been more frequently ob- 
 served in connection with extensive perforations. It would 
 seem to be in the direction of extensive exfoliation of the 
 epithelium, which accumulation undergoes fatty degenera- 
 tion, the fatty products changing later to cholesterine. This 
 condition requires careful cleansing, removal by scoop or 
 pipette syringe, so that accumulations and pressure shall not 
 cause the cancellated tissue to break down. Embolism may 
 occur in some of the larger branches of these tympanic ves- 
 sels : and, in a case recently seen in the Ophthalmic Hospi- 
 tal, I believe this to be the explanation of the condition 
 which exists ; the drum-head, apparently, being changed into 
 a naevus, or mass of venous vessels. 
 
 Cancervi\?iy invade the temporal bones, as well as any other 
 part of the body, and has nothing of particular note in this 
 locality. 
 
 Burnett mentions a case of hairs growing in the cavity of 
 the tympanum and mastoid cells, and a specimen was shown 
 
90 LECTURES ON CLINICAL OTOLOGY. 
 
 by Toynbee. Dr. Tilbury Fox stated that they were nour- 
 ished in the cells, and could not have been introduced from 
 without. 
 
 The exudation of lymph is the last item to notice, and its 
 nature and effect may be understood by the details of the 
 cases which have come under my observation. 
 
 The secretion in the tympanum is a clear, serous fluid, 
 which moves freely in recent cases, so that the line of its 
 level may be seen if the membrana tympani is transparent. 
 When the patient sits or stands, the line is seen horizontally 
 across the membrane; but, on lying supine, the fluid flows 
 into the antrum. Inflation of the cavity of the membrane 
 causes a dissipation of the fluid, and stimulates its absorp- 
 tion. Adhesive inflammation is more likely to follow serous 
 exudation in the middle ear, than simple chronic catarrh : 
 hence it is necessary to watch the after-history, and use 
 inflation to keep the walls separate. 
 
 Hemorrhage in the middle ear is mentioned as a complica- 
 tion of Bright's disease. I am satisfied that it may occur 
 independent of renal disease. 
 
 Mr. R. S., a young man of feeble general constitution, 
 suffered from chronic naso-pharyngeal catarrh : it extended 
 to both tympana. Each winter he had occasional treatment, 
 but never regained the power lost. The drum-heads became 
 very much retracted ; and at last, in one of the acute attacks, 
 the color of the transmitted reflection changed to a dark 
 green, or greenish black. Under treatment, the hearing im- 
 proved, but the color remained the same. Two years ago this 
 winter (1885), the membrane in one ear bulged, without the 
 usual symptoms of acute disease, such as pain, fever, etc. I 
 proposed paracentesis, but it was not allowed. A few days 
 afterward, the drum-head yielded ; and a watery fluid, mingled 
 with dark bloody masses, flowed for a few days. The stuffy 
 sensation, which he had complained of, passed away, and the 
 
UXUSUAL DISEASES OF MIDDLE EAR, 9 1 
 
 discharge ceased. Afterward the drum-head presented an 
 irregular appearance, being bulged at various points over the 
 entire field of view. The left membrane was similar in 
 color, but not lobulated. 
 
 This fall (1884), the right ear began a similar course, feel- 
 ing stuffed ; and the hearing was diminished more than usual. 
 Examination showed two very marked projections at the 
 superior junction of Mt. and meatus; the bulging was very 
 great ; and the external layer of the membrane was whitish, 
 overlying the dark-blue beneath. Any operation was dreaded 
 and refused. After a few days, the tissues yielded, and a 
 similar dark bloody discharge appeared. The projections 
 had receded, but the surface of the drum-head was more 
 irregular than before. It is a matter of regret that the sub- 
 ject of disease is so intolerant of examination and treatment. 
 My view of the case is, that there is a dilatation of the ven3us 
 supply of the tympanum, which is aggravated by attacks of 
 acute catarrhal disease of the naso-pharynx. 
 
 Pulsating Tinnitus in Disease of the Middle Ear. — There 
 is one unusual symptom noticed in some cases of middle-ear 
 disease, — a beating sound synchronous with the impulse of 
 the heart. In studving: these cases, it will be found, that, in 
 many, the subjective sound will be modified by pressure upon 
 the carotid ; and in some instances it has been entirely over- 
 come while the pressure was maintained. While it is true 
 that the existence of middle-ear disease acts to make this 
 form of tinnitus more seriouslv annovins:, I am satisfied that 
 we must be compelled to admit the explanation offered by 
 Dr. Woakes ; viz., that the cause is a lack of vasomotor 
 power, and the impulse of the volume of blood is communi- 
 cated to the vessels of the internal ear quite as forcibly as 
 to the temporal bone as a whole. The cause of the tinnitus 
 is to be found, not so much in the lesion of the middle ear, 
 as in the lack of power in the centres of the sympathetic 
 system of nerves. 
 
 Hjdrobroviie aeid ex^rcisQ^ a control of this condition of 
 the nervous system, and may bring about a cure, as in the 
 followins: case : — 
 
92 LECTURES ON CLINICAL OTOLOGY. 
 
 Miss S., aged thirty-seven. April, 1883. Has had naso- 
 pharyngeal catarrh for over five years ; subject to rheuma- 
 tism ; has been under treatment by a specialist, who relieved 
 the rheumatism, but not the catarrh ; H. D., watch 23-240 
 right, 10-240 left ; has to exercise great care in hearing 
 pupils in school ; can converse readily with single ones if 
 she can see the face ; subject to tinnitus, ringing and beat- 
 ing ; the beating is a regular pulsation, in keeping with the 
 action of the heart ; right Mt. opaque, left Mt. fairly clear ; 
 Et. dilatable ; tissues of pharynx thick and red, very irrita- 
 ble. A mild current of the induced electricity improved the 
 hearing, and reduced the tinnitus temporarily. Various rem- 
 edies were used with little avail. In June she was put upon 
 the use of Jiydrobromic acid each day on returning from 
 school, and has done so, as the symptom required, till the 
 present time (1885), with complete relief of the pulsating 
 tinnitus. Kali pJiospJwriciun has been serviceable in relieving 
 the ringing sounds. 
 
 Diseases of the Middle Ear. — Cases. 
 
 Case No. 8. — Nathan Mars, aged twenty-three. Otitis media 
 catarrhalis acuta. Two weeks ago, by an exposure he took 
 cold. A sense of heat, itching, and burning occurred in the 
 left ear, followed by deafness. Associated with the trouble 
 in the ear is a sore throat, a sense of roughness of the 
 throat, with increase of mucus, and a slight cough. There 
 is also accumulation of mucus in the nares. 
 
 This is a typical case of acute catarrhal inflammation of 
 the middle ear, and in direct contrast to a previous case. 
 Inspection of the drum-head shows that it is sunken, to- 
 gether with hyperaemia, especially at the peripheral margin, 
 and about the attachment of the handle of the malleus. 
 The Eustachian tube is closed. It is necessary in this case 
 to get the tube open, inflate the tympanum, thereby dissipate 
 the mucus, and relieve the approximated surfaces. Should 
 these surfaces remain in contact, an adhesion would occur. 
 Remedies must be administered to correct the existing con- 
 
DISEASES OE MIDDLE EAR. — CASES. 93 
 
 ditions. Such cases as these have been maltreated by 
 aspirating the cavity through the drum-head. By this, you 
 accomplish nothing : the edges approximate, the opening of 
 the Eustachian tube is not facihtated, and the danger of sup- 
 puration is increased. 
 
 Case No. IJ. — Jane O. Shay, aged fifty-two years. Has 
 ahvavs enjoyed good health until one year and a half ago, 
 when she was attacked with catarrh of the nose and pharynx 
 Six weeks asro she was taken with a disacfreeable association 
 of noises in the ear : this has been less annoymg during the 
 last tw^o weeks. Day before yesterday (Xov. ';) she took 
 cold, causmg soreness and deep redness of the throat, an 
 aphthous condition of the mucous membrane of the fauces : 
 the inflammation extended to the ear, causing severe pain. 
 She was placed under the influence of 7na'c. dent, iodide, and 
 to-day is much relieved. The condition has been subacute, 
 tending to chronic : the exposure carried it on to the acute 
 stage, and this is the present state. Please notice the ap- 
 pearance of the membrana tympani, and examine the fauces. 
 
 Case Xo. i^. — Robert Gregg, aged eight years. He was 
 attacked on the 25th of last month (December) with deaf- 
 ness, for which he has been treated, and steadily improved 
 until last night. The tympanic mucous membrane was in 
 better condition, and the naso-pharyngeal catarrh had im- 
 proved ; last night the patient complained of pain ; and the 
 case is to be classed as acute catarrhal, liable to pass on to 
 acute suppuration. The membrana tympani is bulging by 
 the pressure of the accumulation in the tympanum. The 
 mucous membrane of the tympanum in the upper part of the 
 cavity forms a duplicature upon the body of the malleus and 
 incus in such a way that cid-de-sacs lie below the line of the 
 superior wall of the meatus, and secretions may collect m 
 these '''pockets." Von Troltsch has specially described them, 
 hence they are often called "pockets of Troltsch." In a 
 similar case occurring in the person of the daughter of one 
 of our physicians, the inflammation caused bulging at the 
 superior border of the membrane, which looked like a large 
 
94 LECTURES ON CLINICAL OTOLOGY. 
 
 mass of cellular tissue. Firm pressure upon this with a 
 cotton-holder, covered with a tuft of cotton, emptied the 
 pocket, by forcing its contents backward into the cavity of 
 the tympanum, and thus prevented perforation. In this 
 instance the attempt aborted, from the fact, that, being a 
 chronic case, the tissues were unyielding. By pressing the 
 speculum downward so that its inner end will press on the 
 roof of the canal, and looking from below upward, you will 
 the more readily bring the upper portion of the membrane 
 into the field of vision, and thereby notice the abnormal rela- 
 tions of the membrane, of which I have spoken. In some 
 cases, it is necessary to simply puncture the bulging portion, 
 and, with Politzer's method of inflation, evacuate the contents 
 into the canal : you thus relieve the pressure, and prevent a 
 large slough. In others, where this condition has not been 
 recognized, and the slough prevented, a permanent opening 
 exists between the canal and the tympanum. Undoubtedly 
 these may have occurred in some of those cases supposed to 
 be congenital. I agree with the view that there may be a 
 permanent opening between the cavity of the tympanum 
 and the meatus which is congenital (Rivinian foramen). In 
 the person of a medical gentleman of this city, there exists 
 an opening, which is undoubtedly the result of suppurative 
 disease in childhood. Dilatation with a pledget of cotton, 
 the insertion of a cotton tent saturated with vaseline mixed 
 with boracic acid, and the internal administration of kali phos- 
 pJwrica, were effective in checking the suppurative process. 
 
 Master J. D. R., aged ten years. Otitis media catarrhalis 
 aciUa. April i, 1876. Is a member of a catarrhal family. 
 He had discharge from the ear last winter, and for several 
 weeks has had occasional ear-ache on the left side. The 
 meatus is normal ; Mt. depressed ; tissues of the pharynx 
 hypertrophied. Baryta mitr, for snapping noises in the ear 
 when swallowing ; ear was relieved. 
 
 April 15. Took cold, and was confined to the house for 
 a few days. On examination, R. Mt. was found bulging and 
 red, L. oozing a lymphy purulent secretion. Hepar siilph. 
 
DISEASES OF MIDDLE EAR. — CASES. 95 
 
 By keeping the tissues perfectly dry, the lining of the inner 
 third of the canal, both R. and L., exfoliated, leaving Mt. on 
 both sides congested, irregular, and adherent from previous 
 suppurative inflammations. 
 
 1 88 1. In April he had a similar attack. Under the same 
 remedy, followed by kali miu\^ he made good recovery. 
 
 May 4. H. D. 20-20. 
 
 May 15. After a slight ear-ache, severe inflammation set 
 in, and the child was confined to the house for ten days. 
 Under hepar siilpJi. and belladonna the high inflammatory 
 action was controlled, with perforation of the membrane. 
 
 1882. In February a similar attack confined the lad to 
 the house for two weeks. The remedies then used were 
 ferrnm pJios. and chamomilla ; perforation did not occur. 
 
 March 25 to April 13 he was under kali mnr. ; H. D. rose 
 steadily to 20-20. 
 
 April 2^. Catarrhal influenza set in, which was relieved 
 by eupJirasia, and for discomfort in the ear was put upon 
 fermm^ which relieved the condition. 
 
 June 6. He hears 20-20. 
 
 April 23, 1883. Has remained well up to the present 
 time ; Mt. adherent, but hears 20-20. 
 
 Mr. William E., aged thirty years, Otitis media catarrhalis 
 acuta^ with rupture of the Mt., and ecchymosis in same. 
 
 Oct. 9, 1873. Had been under treatment during the pre- 
 vious year for suppuration of the L., ulceration of Mt. and 
 walls of canal ; removed cellular polypus ; ulcer healed ; 
 H. D. 12-240; now suffering from acute bronchitis; the 
 severe paroxysms cause pain in the R. ear ; the right Mt. is 
 congested, and H. D. only 6-240 ; it had been 20-20 when 
 last tested. Gelseminm relieved the pam, but the cough was 
 very severe. Bryonia^ caiistienm, and rnmex in succession 
 failed to relieve, and Oct. 14 the Mt. was ecchymosed at 
 various points. A small clot of blood was removed from one 
 spot. Cotyledon tmib, finally relieved the cough. The con- 
 gestion gradually faded as the hearing improved. 
 
 Dr. F., aged fifty-five years. Otitis media catarrhalis acnta. 
 
96 LECTURES ON CLINICAL OTOLOGY. 
 
 Dec. 16, 1871. Dec. 10 had an attack of influenza; pain in 
 left severe, followed by discharge of yellowish lymph ; total 
 loss of hearing; pain has gradually ceased; H. D., watch, 
 right, 4-20 ; left, -20 ; Mt. and inner third of canal diffuse in- 
 flammation, dermoid layer exfoliated ; when removed, tissues 
 red and moist ; after several attempts, Politzer's method in- 
 flated the tympanum; H. D. right, 5-20; left, c-20. Mer- 
 ctiriiLS viv2t,s was advised, and occasional inflation. 
 
 Dec. 22. Better; H. D. after inflation, right, 15-40; Mt, 
 clearer. Merc. v. 
 
 Dec. 26. Relapsed on account of exposure in the practice 
 of his profession ; hears watch on auricle ; white shreds 
 over Mt. ; made an incision through Mt, ; Politzer ; perfora- 
 tion whistle ; no gain ; no pus in tymp. Mcrciirms. 
 
 Dec. 2Z. Better ; Mt, was healed next morning ; now 
 more clear, folds can be distinguished; Pol. +; Siegel's 
 speculum gives good degree of mobility ; itching in ear ; 
 H. D. 9-240. Sulphur, 
 
 Jan. 5, 1872. Better; H. D. right, 10-20; left, 10-240; 
 Mt. moves more freely. Sulph. 
 
 Jan. 26, Improved; H. D. right, 10-20; left, 30-240; Mt. 
 clear, and good degree of mobility. 
 
 May 17. H. D. 8-20 right and left ; Mt. clear, but slightly 
 depressed. 
 
 Mr. R. M. P., a,G^ed sixty years. Otitis media catai'rhalis 
 acuta. Oct. 2, 1880. Since two weeks he had suffered from 
 head-cold, which caused severe pain in right ear, with sub 
 jective noises ; Mt. thick and reddened ; Et. closed ; H. D, 
 c-20 right, 10-20 left. Ferrum phos. 
 
 Oct. 4. Ear feels clearer; Mt. less red; Et. closed 
 Merc. dulc. 
 
 Oct. 8. Removed exfoliated epithelium ; H. D. c-20; Mt 
 less red. Merc. 
 
 Oct. 13. Better ; Et. dilatable ; Mt. clearer after inflation : 
 H. D. 2-20. Merc. 
 
 Oct. 20. Improving ; removed epidermis thrown off 
 Mt. clearer ; H. D. 3-20 ; Pol. +, then H. D. 3-20. Merc. d. 
 
DISEASES OF MIDDLE EAR. — CASES. 97 
 
 Nov. 10. Patient thinks he hears as well as formerly; 
 Mt. fairly clear, but thick ; inflation easy ; H. D. 10-20 right 
 and left. Probably the hearing of this patient had been 
 below standard previous to this acute disease. 
 
 Case of W. H. H., aged thirty. Grocer, blond, fair degree 
 of health and strength. Has slight naso-pharyngeal catarrh. 
 Sept. 12, 1871. Has had no ear-trouble, to his knowledge; 
 one week ago took cold, and became gradually deaf in left 
 ear ; has been under care of homoeopathic physician with- 
 out relief of deafness ; H. D. R. 20-20, L. -20 ; R. Mt. 
 normal, L. Mi. uniform ; red color, glazed appearance, de- 
 pressed, bones prominent, folds deep ; Politzer's method 
 used, then H. D. L. 10-240; Mt. less depressed, and the en- 
 tire surface covered with rings, formed by bubbles of mucus 
 in the cavity of the tympanum ; repeated the inflation, then 
 H. D. 14-240, and bubbles change their relations ; third in- 
 flation, H. D. 22-240 ; patient has no pain, but a sense of 
 fulness joined with a sound as of bubbles bursting in the 
 ear. Graphites. 
 
 Sept. 13. Better till this morning, when the ear felt 
 closed ; H. D. R. 20-20, L. 6-240 ; Mt. depressed and glazed 
 as before ; Politzer's method -f-> then Mt. less depressed, and 
 inner surface covered by rings as at previous inflation ; sec- 
 ond trial, then 22-240 sound similar to that heard at last visit ; 
 he has bad odor from mouth and nose, and is subject to an 
 itching eruption every summer ; feet cold and sweaty. Sul- 
 pJmr. 
 
 Sept. 14. Better ; Valsalva's experiment -|- ; H. D. 30- 
 240 ; Politzer -[-, then 33-240 before inflation ; Mt. looked 
 more normal, having lost its glazed red look, and was less 
 depressed ; after inflation, there was the same appearance of 
 rings, but the bubbles were fewer and larger. 
 
 Sept. 16. Much the same; Val. +; R. normal, L. H. D. 
 35-240; Politzer's method -\-, then 50-240; Mt. before infla- 
 tion depressed, but more normal opalescence ; after, reddened 
 over upper half and along line of manubrium ; no sign of 
 bubbles in cavity of tympanum. No medicine. 
 
98 LECTURES ON CLINICAL OTOLOGY. 
 
 Sept. 19. H. D. 58-240; inflation, then 5-20; crashing 
 in ears, with dull sensation L. ; excessive secretion of mucus 
 after meals. SidpJmr. 
 
 Oct. 10. H. D. 5-20; inflation, then 15-40; dulness 
 gone. 
 
 Nov. 24. H. D. normal ; L. Mt. more dull than R. ; con- 
 gestion after. 
 
 I have seen this gentleman at times since then, and he 
 has had no repetition of the trouble. 
 
 Cured cases. — Bad effect of the nasal douche. Miss E. P., 
 aged seventeen. Oct. 14, 1882. Has had naso-pharyngeal 
 catarrh for many years. Her father, being a physician, ad- 
 vised the use of the douche with warm milk ; as he had read 
 favorable reports of its use in a medical journal published in 
 Boston, Mass. Upon the second or third trial, the right 
 tympanum was flooded, and an intensely painful otitis fol- 
 lowed at once. I advised the used oi ferrum pJios., and infla- 
 tion with Politzer's apparatus ; relief was given, and to-day 
 she came to my office ; H. D. R. 3-20, L. 10-20 ; R. Mt. 
 congested ; Et. open ; tissues of naso-pharynx thick and red ; 
 excessive secretion of mucus from the same. Hydrastis. 
 
 Oct. 21. Better; "hears as well as ever" (?) ; R. 8-20, 
 L. 14-20; Politzer's method, then R. 10-20, L. 16-20. Her 
 father will continue the remedy. 
 
 Oct. 28. R. 12-20, L. 18-20; Politzer's method, followed 
 by a mild secondary current of electricity ; then R. 14-20, 
 L. 18-20. 
 
 Nov. 18. Has been treated each week. Now R. 2-20, 
 L. 16-20; after the same method of treatment, R. 20-20, 
 L. 18-20. 
 
 Similar results have followed the practice of snuffing salt 
 water, and forcibly blowing the nose immediately afterward. 
 
 Mr. William H. B., aged twenty-five years. Otitis media 
 catarrJialis chrvnica. Jan. 8, 1875. Has been troubled two 
 years with an irritable throat, nervous head-aches ; now trou- 
 bled with ringing in both ears ; meatus normal ; drum-head 
 clear, but depressLcdj Eustachian tube dilatable ; granular 
 
DISEASES OF MIDDLE EAR. — CASES. 99 
 
 pharyngitis; H. D. right, 5-240; left, 1-20; wndQV mejritriiis 
 didcis and spongia, with the use of PoKtzer's method of infla- 
 tion ; on the 23d of March, H. D. 20-20. 
 
 Case II. — Freddie T., aged ten years. Otitis media ca- 
 tarrhalis chronica. May 29. Has suffered since seven years 
 with disease of the left ear. This is an interesting case, on 
 account of the results of the treatment under which he 
 has favorably progressed. The history is one of catarrhal 
 disease. He had been diseased to a greater or less extent, 
 having suffered pain at times, and has been the subject of 
 tinnitus. When he came to us, he was suffering with a sub- 
 acute attack of catarrhal inflammation with slight pain. He 
 was given fe7^ritm pJiospJioricicm, which relieved these symp- 
 toms. There still remained closure of the Eustachian tube, 
 mucous membrane of the pharynx pale. In these conditions 
 he was put on kali muriaticinn, with occasional inflation of 
 the cavity of the tympanum by Politzer's method, with very 
 gratifying results, and now hears normally. Calcarea car- 
 bonica was given for a short time for the anaemia of the rapidly 
 growing child. In kali inuriaticiim you will find one of the 
 most effective remedies for what is popularly known as ca- 
 tarrhal deafness. It has a decided action on the mucous 
 membrane of the naso-pharynx and the Eustachian tube ; the 
 mucous membrane being granular or hypertrophied, as seen 
 in the condition known as pharyngitis folliculosa or granu- 
 losa. But, so far as I have observed, it is perhaps clearer 
 than the cases in which inercitriiLS diilcis has been prescribed 
 with good effect for closure of the Eustachian tube. Its ac- 
 tion is perhaps more on the right side than on the left, and 
 it is indicated by a stuffy cold with greenish yellow discharge, 
 or the more chronic condition with whitish opaque mucous 
 discharge ; and I can substantiate the claim which is made 
 for it, that it renders one less susceptible to cold, as an ex- 
 citing cause of acute catarrh. 
 
 Case No. 12. — George R., aged thirty years. Otitis media 
 catarrhalis cJironica. Nov. 8. For eisfhteen months suffer- 
 ing with disease of the right ear ; freedom from pain, with 
 
lOO LECTURES ON CLINICAL OTOLOGY 
 
 subjective noises. The existing trouble, however, he is 
 inclined to date as far back as four years ago. Eighteen 
 months or two years ago he began to notice failure of hear- 
 ing : this remained stationary for a time. About a year ago 
 the subjective noises of which he complained began : he 
 described these as a hissing. Examination shows that the 
 membrana tympani is depressed, somewhat opaque, due to 
 previous congestions. The naso-pharyngeal mucous mem- 
 brane is secreting excessively, a whitish, opaque mucus, and 
 is follicular or granular ; the Eustachian tube of the right 
 side, closed. This is the brief history of a large number of 
 similar cases. I will treat Mr. R. before you in order to 
 show you how inflation is performed. As I have said to you, 
 Valsalva's method of inflation is an experiment simply, and 
 should not be used as a method of treatment. Yet it is 
 advised by many physicians who are ignorant of its danger 
 and unhappy results. 
 
 Some aurists may have been so imprudent as to do like- 
 wise ; but I think that most know better, and advise against 
 it. 
 
 I will use the Eustachian catheter first on the right side, 
 as you see, and succeed in forcing the air into the middle 
 ear. We will now use Politzer's method of inflation, intro- 
 ducing nose-tip into the opposite nostril ; as, in catarrhal 
 thickening of the nares, the air passes more readily to the 
 ear, than when it is introduced on the same side. Inflation 
 frequently has the effect of decidedly diminishing the sub- 
 jective sounds for the time being, if it does not entirely over- 
 come them. If it simply modifies them, then we may follow 
 the inflation by traction or suction with Siegel's pneumatic 
 otoscope. The membrana tympani being drawn outward, 
 the adhesions which exist in the cavity of the tympanum 
 are subjected to tension, and in some cases the sounds are 
 entirely removed. These distressing sounds in the ear are 
 caused by the pressure of the air upon the membrana tym- 
 pani, without a corresponding pressure of the air in the 
 Eustachian tube, and cavity of the tympanum, air being 
 
DISEASES OF MIDDLE EAR. — CASES. lOI 
 
 excluded by a closure of the former : hence the stapes is 
 forced inward ; and the tension of the labyrinthine fluid is so 
 charged, that the vibrations of the fluids cause an irritation 
 of the terminal filaments of the auditory nerve. The hy- 
 pothesis that, to my mind, best explains this subjective con- 
 dition, is, that the vibrations caused by the flow of the blood 
 through the mechanism of the internal ear are subject to, 
 and modified by, this abnormal interlabyrinthine pressure. 
 These sounds are often our first evidence of what is going 
 on in the middle ear, and much can be done to check the 
 abnormal process which causes them. When anchylosis of 
 the stapes has not occurred, but the tympanic muscles are in 
 an enfeebled, and possibly atrophic, condition, much may be 
 done by the use of electricity. If the tympanic muscles 
 have been in a state of disuse for a great length of time on 
 account of catarrhal thickening, this disuse results, as in all 
 similar cases, in loss of power. If it has existed but a short 
 time, it is readily restored ; but, if continued for many years, 
 the bellies of the tensor tympani and the stapedius muscles 
 undergo fatty degeneration, and possibly form adhesions in 
 some portion of their relations to other parts. The action 
 of electricity is undoubtedly the same upon muscular tissue 
 here, as elsewhere in the human body. 
 
 The galvanic current will affect tissue profoundly in the 
 way of nutrition, and arouse the dormant energies of the- 
 motor nervous supply. Applications of the Faradic or in- 
 duced current increase muscular activity, and overcome the 
 atrophic condition of the muscles themselves. There is 
 much scepticism on the part of members of the profession 
 in regard to the use of the electric current in diseases of the 
 ear. Many European aurists, however, as Brenner, Field, 
 and Woakes, are strong advocates of its use. It is a matter 
 worthy of remark, that those who have used it the least are 
 most sceptical concerning its value ; while those who are 
 acquainted with its 'sphere of action, by oft -repeated applica- 
 tions, are most enthusiastic in its favor. 
 
 Mr. S. C. B., aged fifty-five years. Otitis media catarrhalis 
 
102 LECTURES ON CLINICAL OTOLOGY. 
 
 cJironica. March 4, 1874. Had naso-pharyngeal catarrh, 
 according to his own statement, five years, but undoubtedly 
 longer. Canal is normal ; Eustachian tube dilatable ; Mt. 
 thick, but fairly movable; H. D. right, contact-20; left, 1-240. 
 Kali Jiydriod. Improved steadily under this and iodide 
 of baryta until May 27, when H. D. in right was 30-240; 
 left, 40-240. He then omitted treatment for a month, and 
 relapsed ; was under treatment until July 22, when the hear- 
 ing had advanced to 3-20 right and left. He omitted treat- 
 ment again for a month, and relapsed to 18-240 and 21-240; 
 under treatment he again improved. 
 
 Dec. 2. H. D. right, 28-240 ; left, 40-240. Omitted treat- 
 ment until 1876. Dec. 6. H. D. 2-240 right and left. Under 
 treatment with merairius dulcis and baryta imir. till Feb. 7 ; 
 7-240, right ; 8-240, left. Was not seen again until Oct. 2, 
 1877, when his hearing had fallen to 2-240 and 4-240. Under 
 treatment at intervals until Feb. 18, when H. D. was 9-240 
 and 10-240. Omitted treatment until the fall of 1878, when 
 H. D. was 5-240 and 6-240. A few treatments sufficed to 
 bring it up to 6-240 and 8-240, when he became completely 
 discouraged, and abandoned treatment. This case illustrates 
 the necessity of continuous treatment in order to preserve 
 even a fair degree of hearing-power in advancing years. It 
 is to be noted, that, although the improvement was marked 
 in a year, the relapses were more decided, and the degree of 
 restoration much less. I am convinced, by successes secured 
 in similar cases, that continuous treatment, even at more pro- 
 longed intervals, will conserve the hearing-power to a very 
 large degree, but that spasmodic treatment is very unsatis- 
 factory. 
 
 Mrs. G. G. H., aged thirty-five years. Otitis media catarrJi- 
 alis chronica. April 6, 1881. Since six months has suffered 
 from prostration after lung-fever, then confinement, with very 
 tardy convalescence. Both ears were affected, without pain, 
 with subjective noises ; meatus normal ; Mt. depressed ; ex- 
 cessive naso-pharyngeal catarrh ; Eustachian tubes dilatable ; 
 theie are symptoms of specific disease. The child was short- 
 
DISEASES OF MIDDLE EAR. — CASES. IO3 
 
 lived. The mother lost nearly all her hair. The history of 
 the case, as given me by the family physician, was somewhat 
 obscure ; and he was unable to make it clear, even to his own 
 satisfaction. H. D. 19-240 right and left. StiycJinia and 
 mild Faradic current. 
 
 April 1 1. Better ; head stronger ; noises less ; H. D. 28-240. 
 
 April 18. Better; head still stronger; noises still less; 
 H. D. 33-240. 
 
 April 27. The same ; H. D. 46-240, right ; 38-240, left. 
 
 July 19. Has continued to improve until this date under 
 Faradism after May 9. Received yrrr/zw/Z/^j"., baryta nuLr.^ 
 and sidpJiur for varying symptoms of the naso-pharynx ; 
 H. D. 20-20 right and left. 
 
 I have seen this patient occasionally since the above date, 
 using Faradism and various remedies for the subjective 
 noises with relief, but have never succeeded in completely 
 overcoming the hyperaesthesia of the auditory nerve. 
 
 Miss A. F., aged thirty years. Jan. 8, 1877. Since one 
 year has been troubled with catarrhal disease affecting both 
 ears. After an acute attack, has ringing in both ears ; appear- 
 ance nearly normal, except the Mtt. depressed ; she has naso- 
 pharyngeal catarrh ; H. D. right, 6-240 ; left, 6-20 ; under 
 vcrbascinn for a catarrhal cough worse at night ; ;;^^;r//rai- 
 diilc. for a relapse, increase of noises ; cJiiniimm, sulpJi., pJios- 
 pJiorns, baryta, ai'scniciLviy with the continuous current, up to 
 the 22d of March, and the secondary current up to the 3d 
 of July; H. D. improved to normal; subjective sounds very 
 slight indeed. 
 
 Mrs. M. S. G., aged thirty-five years. Otitis media ca- 
 tarrJialis chronica. Nov. 16, 1878. For two weeks has had 
 trouble with the right ear from cold ; the right side of the 
 neck is infiltrated, and all the region about the meatus 
 anteriorly and posteriorly very sensitive to touch ; the canal 
 is normal ; Mt. depressed ; naso-pharyngeal catarrh ; Eusta- 
 chian tube closed ; H. D. 3-240. Her family physician had 
 prescribed the internal remedies, and desired her to have 
 the benefit of such mechanical treatment as was indicated in 
 
I04 LECTURES ON CLINICAL OTOLOGY. 
 
 the case. Under inflation by Politzer's method, the use of 
 a mild galvanic current for the first week, followed by the 
 secondary current, she improved rapidly until Dec. 28, when 
 H. D. was 20-20 right ; H. D. in the left ear was unusually 
 acute, giving a record of 30-30. 
 
 Miss E., aged twenty-four years. Otitis media cataj'rhalis 
 chronica. May 11, 1874. For two days has had trouble with 
 both ears ; sudden loss of hearing, without subjective noises ; 
 Mt. depressed, thin ; has follicular pharyngitis ; Eustachian 
 tube dilatable ; H. D. right, 27-240 ; left, contact. Kali Jiy- 
 driod. Relieved by inflation, Politzer's method. 
 
 May 16. Subjective noises have set in ; H. D. 10-20 right 
 and left; after inflation, right, 20-20; left, 16-20. Cotyledon 
 nnib., to relieve the bubbling sound in the right ear, as though 
 there were mucus in the tube. 
 
 May 21. Subjective noises ; H. D. 16-20 and 12-20 ; after 
 inflation, 18-20 and 14-20 ; itching deep in the ear, as though 
 in the Eustachian tube. Caiisticnni. 
 
 May 27. Subjective sounds have ceased ; H. D. the same 
 as at last date ; after inflation, 18-20 and 16-20. 
 
 Oct. 12. H. D. 18-20 right and left; has remained free 
 from subjective sounds since previous visit. 
 
 Miss M. S. D., aged thirty years. Otitis media catarrJialis 
 cJironica. May 2, 1877. Has had naso-pharyngeal catarrh 
 for years ; gradual loss of hearing, without subjective sounds. 
 Dr. Knapp gave an unfavorable prognosis. Mt. depressed ; 
 Eustachian tube dilatable ; tissues of pharynx hypertrophied ; 
 H. D. 4-240 right and left. Mild galvanic current, as before 
 suggested ; the negative pole at the trifacial, the positive on 
 the tongue. Kali Jiydriod. 
 
 May 16. Improving; H. D. right, 6-20; left, 12-20. 
 
 June I. Continued under the same remedy, with mild 
 applications of the Faradic current, following the galvanic 
 current ; had one slight relapse, affecting the ear only, and 
 has heard 20-20 since the 25th ult. 
 
 Miss C, aged twenty-five years. Otitis media catarrhalis 
 chronica. April 7, 1877. Since two years has had catarrh; 
 
DISEASES OF MIDDLE EAR. — CASES. I05 
 
 H. D. right, 7-240; left, 18-20; meatus normal; Mt. de- 
 pressed ; Eustachian tube closed ; pharynx granular. Re- 
 ceived merciiriiis. 
 
 April 30. Right, 10-20; left, 20-20. 
 
 IMay 28. Better under kali Jiydriod. ; improved steadily ; 
 H. D. 14-20. 
 
 June 4. H. D. 20-20 ; yawning, sneezing, clearing the 
 throat, and any other muscular action of the pharynx, cause 
 snapping, cracking in the ear. Relieved \iy gelsemium. 
 
 ]\Ir. X. ]\I., aged fifty years. Otitis vicdia catarrJialis 
 chronica. June 6, 1878. After the removal of an accumula- 
 tion of cerumen from the canal, the hearing was very dull. 
 J///, congested ; H. D. right, 24-240 ; left, 44-240. Under the 
 action of nicrcurins dulc, with inflation by Politzer's method 
 two or three times a week, on the first of July the patient 
 heard 18-20 right and left. I had to see the patient occa- 
 sionally in later months ; have heard from him, through 
 friends, up to the present season, and understand that the 
 benefit has been a permanent one. 
 
 Application of the secondary current. — ]\Irs. C. A. A., aged 
 thirty-one years. Jan. 10, 1880. Eleven years ago had ab- 
 scesses in both ears. Recently, ringing has set in, in both 
 ears ; hears with right ear, 5-240 ; left, 7-20 ; meatus normal ; 
 membrana tympani adherent ; pharynx .eranulated : Eusta- 
 chian tube dilatable. Under kali hydriod., and the application 
 of electricity in the same way, the patient improved so that, 
 at the close of treatment, on Eeb. 11, 1880, she hears with 
 the right, 10-20; left, 18-20. 
 
 Mrs. B., aged forty years. Otitis media catarrhalis cJironica. 
 April 23, 1877. For seven or eight years has noticed a 
 gradual loss of hearing on both sides ; now troubled by low 
 roaring, especially annoying when quiet. The membrane is 
 depressed ; the tissues of the naso-pharynx thin, atrophied ; 
 Eustachian tube easilv dilatable ; hearino:, on the ris-ht side, 
 1-480; left, 14-240. She has received niercurius dnlcis. ■ Treat- 
 ment continued through April and ^lay, up to the 9th of 
 June. Constant current, from 5^ to 10^. 
 
I06 LECTURES ON CLINICAL OTOLOGY. 
 
 June 9. H. D. right, 18-240; left, 6-20. During the month 
 of May, she was under kali Jiydriod. 
 
 Master W. O., aged sixteen years. Otitis media catarrJialis 
 cJironica. Oct. 21, 1873. Seven years since, had scarlet- 
 fever ; has been losing hearing gradually during the last six 
 months, with subjective noises; H. D. right, 3-240; left, 
 1-240; meatus is normal; Eustachian tube dilatable; Mtt. 
 depressed ; tissues of the throat thick, but not granulated. 
 Under kali hydidod.., with occasional doses of merctiritis, for 
 acute conditions. 
 
 Nov. 1 1. He hears 20-20 right and left. 
 
 Jan. 8, 1874. He had omitted treatment for nearly a 
 month. Under treatment till April 15, when the hearing 
 was 20-20 again. 
 
 May 18. Acute inflammation set up in the right ear, 
 caused by a carious tooth ; H. D. 3-2-40 ; the tooth was ex- 
 tracted, and he was under treatment. 
 
 July 10. H. D. 14-20; was not seen again until April 11, 
 1875, when he had relapsed, and had had ear-ache the previous 
 week; H. D. right, 3-240; left, 1-240. 
 
 Although the parents of this child were wealthy and intel- 
 ligent people, they abandoned treatment because the result 
 obtained was not a permanent one ; although the relapses 
 were clearly traceable to the causes above noted. 
 
 Miss R., aged thirty years. Otitis media catarrhalis chron- 
 ica. April 8, 1878. For two years and a half has suffered 
 from subjective noises in the left ear, caused by successive 
 colds; H. D. right, 16-20; left, 14-240; drum-head not espe- 
 cially abnormal in appearance, except depressed ; Eustachian 
 tube dilatable ; in the naso-pharynx, granular pharyngitis. 
 Merctiritis diilc, with occasional inflations. 
 
 April 29. Has improved steadily, except for the voice ; 
 H. D. right, 20-20; left, 18-20. 
 
 June I. Subjective noises very much relieved ; H. D. for 
 the watch was normal, and for the voice very much improved. 
 This case is one of those exceptional ones, in which the hear- 
 ing for the voice does not gain to a degree parallel with 
 that for the watch. 
 
DISEASES OF MIDDLE EAR. — CASES. lO/ 
 
 Mr. E. W. C, aged sixty years. Otitis media catarrhalis 
 cJironica. Oct. 30, 1876. P'or years has had naso-pharyngeal 
 catarrh. Has suffered now for four weeks from an attack of 
 suppurative disease ; the usual acute symptoms ; H. D, right, 
 1-240 ; meatus normal ; Mt., which was oozing a muco- 
 purulent secretion at the time he was visited at his house, 
 is now thick and retracted ; follicular pharyngitis with a 
 decided ozaenic odor. Mercii7'ius dulcis. 
 
 Nov. 14. Has been under this remedy until this date; 
 H. D. right, 14-240 ; left, 38-240; his voice sounds strangely 
 to himself, as though passing through the ears. Cansticinn. 
 
 Nov. 24. Improving ; H. D. 42-240 and 46-240 ; troubled 
 by a rattling cough. Sanibiicus. 
 
 Dec. 2. Improving ; H, D. 5-20 and 8-20 ; cough relieved. 
 Mcrcui'itcs didc. 
 
 Jan. 22. H. D. 10-20 and 1420; Politzer -f ; H. D. 18-20 
 right and left. 
 
 Sept. 3, 1881. Has been well until this date; from expo- 
 sure, had acute catarrhal inflammation of the naso-pharynx, 
 which involved the left ear ; walls of the meatus red ; Mt. 
 congested ; roaring in the left ear. Feri'itni pJios. 
 
 Sept. 15. Seen twice ; is much better; hears well enough 
 to suit himself. 
 
 Oct. 6. Not as well; subjective sounds in left ear in- 
 creased ; applied mild Faradic current, the positive pole to 
 the trifacial, the negative to the tongue. Mcrciiiius diilc. 
 
 Oct. 10. Noises still troublesome ; less after application 
 of the galvanic current. Kali viiir. 
 
 Oct. 2^]. Subjective sounds ceased ; meatus normal in 
 appearance ; Mt. free from congestion ; has been under kali 
 inur. until this date. Although this patient did not have 
 normal hearing for the watch, he is well satisfied with the 
 results of the treatment. 
 
 Mr. R. S. S., aged twenty-five years. Otitis Dicdia catarrJi- 
 alis chronica. Nov. 29, 1876. Had scarlet-fever when three 
 years old, when the ears discharged. Since then he has had 
 occasional attacks with subjective sounds, and the hearing 
 
I08 LECTURES ON CLINICAL OTOLOGY. 
 
 has lately grown quite dull from repeated colds. H. D. right, 
 contact-20 ; left, 8-240 ; canal very narrow ; drum-head not 
 much thickened ; tissues of the pharynx hypertrophied ; 
 Eustachian tube dilatable. Under vierciLritLS ditlc. for the 
 acute condition, and baryta in?ir. for the subjective sounds 
 caused by swallowing, yawning, or any other muscular action 
 of the pharynx, there was improvement ; H. D. rose to right, 
 10-240; left, 12-240. During four years the young man was 
 away at college, and visited me occasionally. During the 
 holiday vacation of 1879-80, the irritability of the throat was 
 increased to such a degree by an acute cold, that even slight 
 pressure upon the larynx caused spasmodic action, so that it 
 seemed as if the patient would strangle. This was relieved 
 hy lachcsis. During 1880 and 1881, the acute conditions of 
 the mucous membrane were relieved by niemirius d?ilc., the 
 spasmodic conditions by lacJiesis and baryta inur. In June, 
 1 88 1, I received a letter from the patient, describing a spasm 
 of the larynx in connection with a cough, which led me to 
 prescribe magnesia pJios. ; and, in reply, he stated that it 
 acted like magic. Since that time he has insisted on keep- 
 ing that remedy by him. As regards H. D., there is no 
 marked improvement to report. 
 
 Electricity. — Dr. P., aged forty-five years. Oct. 19, 1877. 
 In March, 1876, had acute otitis media, affecting the left side. 
 Seeks relief from a distressing hissing ; hears right, 4-20 ; 
 left, 10-240. Constant current, positive pole to the left ear, 
 negative pole to the hand on the opposite side, 15°, allowing 
 the current to run five minutes ; hears 20-240. Salicylate 
 of quinine. 
 
 Oct. 22. Right hears 6-20 ; left, 16-240; no hissing ; 15°, 
 constant current ; shprt sitting ; right, 7-20 ; left, 2-20 ; head 
 clearer. Salicylate of qninine. 
 
 Oct. 26. Right, 7-20 ; left, 2-20 ; after exposure, and loss 
 of sleep, ringing set in again; 15°, 17,000; hissing ceases; 
 right ear, 8-20 ; left, 20-240. 
 
 Nov. 5. Right, 10-20; left, 30-240; hissing sound; 10°, 
 16,000; hissing ceases at once; hears with right, 16-20; left, 
 the same as before sitting. 
 
DISEASES OF MIDDLE EAR. — CASES. IO9 
 
 Nov. 9. Had cold in the head, which did not affect unfa- 
 vorably ; right, 16-20; left, 20-240; 10°, 15,000; current ap- 
 plied with the positive pole on the tongue, and the negative 
 pole on the trifacial in front of the ear ; at the close of the 
 sitting, right, 20-20 ; left, 37-240. 
 
 Nov. 15. Better; right, 20-20; left, 37-240; application 
 in the same manner and the same force ; right, 20-20 ; left, 
 46-240. 
 
 Not seen until Dec. 13. Relapse from cold ; right, 14-20 ; 
 left, 35-240; application of the same force and in the same 
 manner; right, 20-20; left, 52-240. 
 
 The gentleman purchased a battery, and uses it himself. 
 
 Miss Mary T., aged fourteen years. Otitis media catarrJi- 
 alis cJironica. Nov. 24, 1878. Five or six years ago had 
 scarlet-fever, affecting both ears ; no pain at present, but 
 subjective noises; H. D. right, 4-20; left, 5-20; the canal is 
 normal ; Mtt. depressed ; tissues of the pharynx thickened ; 
 Eustachian tube dilatable; after Politzer, H. D. right, 8-20; 
 left, 30-240. The patient improved steadily, under meratriiis 
 dulc, until Dec. 3, then inerciLriiLS protoiodide until Jan. 4, 
 when H. D. was 20-20. 
 
 Mr. C. W., aged twenty years. Otitis media catcrrJialis 
 chronica. Oct. 2, 1873. From some unknown cause, he has 
 had gradual loss of hearing after ear-ache in the left ear 
 eleven years ago ; both ears affected with subjective noises ; 
 H. D. right, 3-240; left, 1-240; the canal is normal ; Mtt. de- 
 pressed and adherent ; Eustachian tube dilatable ; tissues of 
 the pharynx thickened. This patient was treated by the 
 passage of a galvanic current through the Eustachian tube 
 and middle ear, by the application of tongue-spatula elec- 
 toid to the positive pole, the negative pole being applied to 
 the meatus, one per cent solution of the iodide of potassium 
 having been injected in the middle ear by Gruber's method ; 
 after the passage of the current, H. D. right was 6-240 ; left, 
 2-240. Kali hydriod. internally. 
 
 Oct. 9. He had improved materially ; H. D. right, 47-240 ; 
 left, 5-20 ; after the passage of the current, and Politzer, 
 right, 6-20 ; left, 8-20. 
 
no LECTURES ON CLINICAL OTOLOGY. 
 
 This treatment was continued until Nov. 12, when H. D. 
 was 1 2-20 right and left. 
 
 Jan. 5, 1874. H. D. 14-20 right and left; after treatment, 
 16-20 right and left. This is after an interval of about six 
 weeks. Eustachian tube is dilatable, Mt. much clearer ; and 
 the result was so satisfactory, that, contrary to my solicita- 
 tion, the patient refused further treatment. 
 
 Oct. 25, 1877. The patient called on me, and stated, that, 
 for the last year, he had gradually failed in power to hear ; 
 but he could not be induced to resume treatment. H. D. 
 right, 3-240 ; left, 6-240. 
 
 Mr. A. S. L., aged forty-five years. Otitis media s2LppiLra'- 
 tiva actita. Sept. 17, 1873. Has been suffering one week ; 
 left ear affected ; while snuffing cold water for the relief of 
 catarrh, sudden pain set in, with subjective noises ; H. D. R. 
 18-240, L. -20; right meatus normal; right Mt. dull; naso- 
 pharynx, catarrhal mucous membrane ; left meatus con- 
 gested ; left Mt. congested and thick ; Eustachian tube 
 dilatable. He was put on vierciLrius with belladonna to be 
 taken in case of severe pain. After treatment with Politzer 
 on the 30th of September, he hears contact-20 with left ear. 
 
 Oct. 2. He took cold, and relapsed. 
 
 Oct. 29. Has improved steadily under vieixurius, and 
 hears right, 34-240 ; left, 5-240. 
 
 Nov. 12. Still improving; H. D. R. 4-20, L. 3-20. He 
 then omitted treatment. 
 
 In 1879 I treated him for facial neuralgia involving the 
 ear, and again in 1877 for facial neuralgia; both times re- 
 lieved him hy plantago maj. ; the hearing remained about the 
 same, 3-20 right and left. 
 
 This case illustrates the mischief which may come from 
 snuffing water, as well as from the nasal douche. 
 
 Miss L. E. P., aged thirty years. Otitis media suppurativa 
 acuta. Nov. 16, 1875. Has had catarrhal trouble for years, 
 "with occasional ulcers in the ear;" hearing has gradually 
 failed within the last few months ; both ears are involved ; 
 no pain; subject to noises; H. D. right, 4-20; left, 6-20; 
 
DISEASES OE MIDDLE EAR. — CASES. 1 1 I 
 
 pus in both canals ; right and left Mt. ulcerated ; granular 
 pharyngitis. Merctirms aide, under which she improved. 
 
 Jan. 8. Had intermittent fever ; and the discharge of pus 
 increased, so much so, that a so-called *' regular" practitioner 
 insisted upon local treatment for the suppurative condition, 
 and touched the suppurating surfaces, both right and left, 
 with nitrate of silver, the result of which was a perforation in 
 the Mt. on both sides ; and the patient has come to me in great 
 alarm ; H. D. right, 4-240 ; left, 30-240. By local treatment 
 with absorbent cotton, and occasional inflation by Politzer's 
 apparatus, internal administration of merciiriiLS, on the 13th 
 the perforation on the left side nearly closed ; H. D. right, 
 3-20 ; left, 4-20. The treatment was continued through the 
 month of January. 
 
 Feb. 3. H. D. right, 6-20 ; left, 10-20 ; perforation in the 
 right ear clear, with a very slight secretion of pus. With 
 some slight relapses, the case progressed until the 24th of 
 March, when both perforations closed ; R. Mt. was adherent ; 
 left free ; H. D. right, 4-240 ; left, 14-20. 
 
 Nov. 21, 1876. Opacities clearly defined in both Mtt. ; 
 H. D. right, 4-240 ; left, 16-20. 
 
 Master F. W., aged fourteen years. Otitis media suppura- 
 tiva aciLta. March 3, 1879. During an attack of scarlet- 
 fever, suppurative inflammation set in, involving both ears ; 
 Mt. bulging, and oozing a thin muco-purulent secretion. The 
 patient was attended at his home daily until the 17th ; both 
 canals being dried carefully, and all secretions removed from 
 Mt. ; both drum-heads perforated, but these perforations 
 closed in a few days. 
 
 The patient was treated occasionally until May 23, when 
 H. D. was 20-20 right and left ; Mt. showing only slight 
 opacities as the result of the inflammation. 
 
 Mr. C. S. P., aged thirty-five years. Otitis media szipp?ira- 
 tiva acuta. Feb. 10, 1881. Had trouble with his ears when 
 a child, from scarlet-fever. Suppuration set in a week ago 
 from exposure to cold ; the canal, pus in the inner third ; 
 Mt. granulated ; tissues extremely sensitive to the touch. 
 
112 LECTURES ON CLINICAL OTOLOGY. 
 
 hepar snlpJi. Patient was under treatment at his residence, 
 where he was visited during the remainder of the month, 
 making rapid progress under hcpar sulph., kali pkos., and 
 silicea. During the month of March he made rapid progress 
 under incrciirius and silicea, when H. D. right was 15-20; 
 left, 12-20, During the month of April suppuration entirely 
 ceased ; the tissues became dry, and somewhat rigid ; H. D. 
 right, 3-20 ; left, 4-20. Under kali chloridimi, H. D. improved 
 steadily, better for voice than watch ; June 20, for the watch, 
 6-20. 
 
 Case I ^. — Joseph McE., aged twenty-five years. Otitis 
 media suppurativa acitta. Sept, 25, 1882. This patient was 
 taken with suppurative inflammation of the middle ear, 
 complicated by a pre-existing catarrhal tendency. His con- 
 dition was one of great constitutional disturbance, — severe 
 pain, high fever, temperature 101° and 102°, with corre- 
 sponding rise of pulse. The auricle and meatus were exces- 
 sively tender to touch, and the mastoid process red, swollen, 
 and bulging at one point. Hcpar sidph. was administered, 
 with no relief. The high fever continued, accompanied by 
 severe throbbing of the arteries, especially of the head, for 
 which ferrum pJiospJioriciim was given every half -hour. The 
 following day the pulse was reduced in frequency, the tem- 
 perature was only slightly above the normal, and, upon the 
 mastoid process, the suppuration had raised the tissues 
 above the surrounding surface, to the extent of about fifteen 
 millimetres. The tenderness of the mastoid process had 
 very much diminished, but at this point was so sensitive 
 that it was impossible to touch it with the scalpel. Taking a 
 curved bistoury, and gauging the motion of my hand to take 
 the limits of this projecting portion, I suddenly passed it 
 from below upward through the elevation, opening it com- 
 pletely, and giving exit to a large amount of dark and very 
 fetid pus. This aperture was kept open by the introduction 
 of a tent, and in a few days all tenderness disappeared. The 
 opening was maintained until the tent was forced out by the 
 tissues closing from below ; and, before this was entirely 
 
DISEASES OF MIDDLE EAR. — CASES. II 3 
 
 closed, the membrana tympani had returned fairly to its 
 function. You will readily notice the tract of the incision, 
 and by percussion and pressure you will detect no disturb- 
 ance of the integrity of the bone. 
 
 This patient recovered such a degree of functional activity, 
 that he was unconscious ot any difference of hearing on the 
 two sides, and could see no further occasion for continuing 
 the treatment, which he was urged to do, in order to bring 
 the hearing as near the normal standard as possible. 
 
 I am satisfied that the remote results which follow many 
 of these cases can be avoided if the patients can be induced 
 to continue the treatment for a greater length of time after 
 such acute disease. 
 
 Case g. — Patrick B., aged sixteen years. Otitis media 
 suppurativa acuta. When crossing the ocean, he received an 
 injury in the ear by being struck with a tin pan. Acute in- 
 flammation set in ; an abscess, or "healing" as the Irish call 
 it, followed ; and a suppurative process was quickly estab- 
 lished. When first seen in the clinic of the Ophthalmic 
 Hospital, the pain, which had not intermitted since the 
 injury, was excessive ; pulse and temperature high, the whole 
 side of the head corresponding to the right ear indurated, 
 sore, excessively sensitive, and accompanied by discharge 
 from the ear. The blow with the tin pan acted as a blow 
 upon the side of a child's head frequently does, when given 
 by the parent or school-teacher in a passion of anger. In 
 these cases, the hand is often used cup-shaped, causing a 
 more severe blow as it gathers the air, forcing it into the 
 ear in addition to the direct force of the hand. When a 
 child, cuffed in this manner, is suffering with a pre-existing 
 catarrhal affection of the ear, it is an easy matter to cause 
 a rupture of the drum-head with serious results. There was 
 no doubt of a catarrhal disease existing in this patient's ear 
 before he received the injury on ship-board ; and, when struck 
 by the pan, the tissues passed on to a suppurative inflamma- 
 tion, much more readily than they would have done if the 
 middle ear had not been the subject of subacute catarrhal 
 
114 LECTURES ON CLINICAL OTOLOGY. 
 
 disease. The second day after the blow, an abscess had 
 formed (as the people say). The case has progressed favora- 
 bly under treatment, so that the discharge has changed from 
 a purulent character to that of a more decided mucous 
 nature, and has lessened very much in amount. The tissues 
 of the meatus are becoming more normal in appearance. 
 The prognosis is favorable. There may result some slight 
 impairment of the hearing. This can be avoided only by 
 care over a somewhat prolonged period, after these acute 
 symptoms have subsided. The treatment in this case has 
 been instillation in the ear of ten drops of calendula tincture, 
 and half an ounce each of glycerine and water. Internally, 
 ferruvi pJwspJioricnm has been given two days after his ad- 
 mission to the clinic. On the third day the acute symptoms 
 have abated, when hepar sidph. calc. was given. Under this 
 the tenderness is less, and the suppuration measurably con- 
 trolled. 
 
 This case progressed favorably, and was dismissed with no 
 perceptible loss of function. 
 
 Case 7. — William C, aged thirty-five years. Otitis 7nedia 
 suppurativa acuta. The right ear has troubled him for three 
 months. The trouble began after an exposure to cold, as a 
 severe burning pain felt more during the night, although not 
 much mitigated through the day. It thus continued for two 
 days, when a discharge appeared, which still continues. 
 
 The appearance of the discharge brought relief from the 
 excessive pain ; but there have been occasional exacerbations 
 of suffering, although the discharge has continued. Upon 
 an increase of the flow, the patient has suffered less pain. 
 The case has progressed to such a point, that, unless the 
 inflammatory action ceases, the accumulated pus will cause 
 spontaneous perforation of the drum-head, and more or less 
 sloughing will result. As not all the members of the class 
 will be able to examine the patient, I will describe what is 
 found on inspection : A case of acute suppuration of the 
 middle ear, tending to the breaking down of the drum-head. 
 The canal is occluded more or Jess with pus. Upon drying 
 
DISEASES OF MIDDLE EAR. — CASES. I I 5 
 
 the canal, as you look inward you see the whole membrane, 
 under the thin coating of purulent secretion, is covered with 
 elevated granulations. These are not healthy, but tend to a 
 chronic condition, and are often the basis of granulation 
 tumors, — so-called polypi. In these cases, internal remedies 
 should be given to lessen the inflammation of the Eustachian 
 tube and middle ear. Inflation of the cavity of the tympanum 
 will separate the membrana tympani from the labyrinthine 
 wall, and bring all the parts involved to a more normal posi- 
 tion, thereby modifying the circulation, and in many cases 
 relieving the pain, so that the process of repair is more likely 
 to proceed. Paracentesis as a means of cure is not indicated ; 
 because the case has, in my judgment, gone beyond the point 
 in which it would be of value. If the drum-head were bul- 
 ging at one point, I should consider it advisable to puncture 
 the membrane, and expel the contents of the cavity of the 
 tympanum into the meatus auditorius externus, if it were 
 possible to do so by inflation, or by suction, drawing the con- 
 tents out into the meatus. But if the membrane is involved 
 through its whole extent, and is transuding the contents 
 of the tympanum, I have found paracentesis to result in an 
 extensive slough ; whereas, by keeping the canal and drum- 
 head as dry as possible by the use of absorbent cotton, I 
 usually succeed in preventing loss of the membrane. The 
 remedy best indicated in this case is kali imiriaticimi ; and 
 in cases of excess of febrile ^yxVi'^\.ov[i^, ferrum pJiosphoricinii, 
 to be given dissolved in water every half-hour. 
 
 Master H. T., aged twelve years. Otitis media siippitra- 
 tiva acuta. May 6, 1876. Three weeks ago had scarlet- 
 fever and diphtheria ; was taken suddenly with ear-ache, fol- 
 lowed by discharge from both ears ; right meatus filled with 
 pus ; on drying the canal, right Mt. is found perforated and 
 sodden ; left meatus in the same condition ; left Mt. in the 
 same condition ; Eustachian tube dilatable ; tissues of the 
 throat hypertrophied. Calca7'ea iod. 
 
 May 10. Much improved-; right canal dry; in rights//, 
 perforations closed ; tissues thick ; in left meatus some pus ; 
 
Il6 LECTURES ON CLINICAL OTOLOGY. 
 
 left Mt. healed, but injected; condition of the pharynx im- 
 proved ; H. D. right, 41-240; left, 18-240; Politzer, then 
 right, 3-20 ; left, 4-20. Mercuriits viv. 
 
 May 19. Condition much improved; hears much better; 
 H. D. right, 14-240; left, 10-240; Politzer, then right and 
 left, 8-20. 
 
 June 7. Discharge much less ; hearing improved ; in left 
 meatus, granulations in inner third ; right Mt. adherent ; 
 left Mt. thick, yellow. 
 
 Continued to improve until July i, when there were scales 
 of cerumen over L. Mt. ; H. D. right, 12-20; left, 16-20; 
 Politzer, then right, 18-20; left, 20-20. 
 
 June 22. H. D. normal ; meatus right and left clear ; Mt. 
 fairly normal. 
 
 Dec. 13. Has suffered relapse in the left ear; left meatus 
 is filled with pus ; on removal, Mt. is found ulcerated, but 
 not perforated ; H. D. right, 20-20 ; left, contact-20 ; Politzer, 
 2-240 ; excessive catarrhal discharge from nose and naso- 
 pharynx, bland, yellow, more mucus than pus. Pidsatilla. 
 
 Dec. 16. Much better ; H. D. 3-240 ; Politzer, then 12-240 ; 
 discharge from meatus more mucus than pus. Pidsatilla. 
 
 Dec. 20. Improving ; H. D. 13-240; Politzer, then 24-240; 
 the appearance is the same. 
 
 Dec. 23. Improving; H. D. 18-240; Politzer, then 3-20; 
 small amount of pus on the walls of the canal ; shreds on 
 Mt. ; complained of lameness ; severe pain in right leg ; pain 
 better by motion. Rhus. 
 
 Dec. 27. H. D. 4-20 ; Politzer, then 8-20 ; dry scales on 
 Mt. Merctiriiis dulc. 
 
 Jan. 6. Improving ; H. D. 8-20 ; Politzer, then 14-20 ; canal 
 dry ; Mt. dry. Merairius dulc. 
 
 Jan. 13. Hearing very much improved; H. D. 18-20; Polit- 
 zer, then 20-20 ; tissues of the canal scaly ; Mt. somewhat 
 scaly ; lameness somewhat improved, but the cause of more 
 complaint than the ear-symptoms. Rhus. 
 
 May 14. Left ear is again affected ; had severe ear-ache 
 last evening and night ; the meatus contains a small amount 
 
DISEASES OF MIDDLE EAR. — CASES. II J 
 
 of pus ; Jit. is infiltrated, and naso-pharynx engorged and 
 red. Mcrcuriiis viv. 
 
 ]\Iay 17. ]\Iuch better ; no pain since last date; tissues of 
 the canal dry ; Mt. dry and depressed. Merciirius dulc. 
 
 May 24. Both ears very dull ; H. D. right and left, 6-20 ; 
 appearance of tissues much the same ; Politzer, then H. D. 
 right and left, 20-20. Merciiriiis dulc. 
 
 May 31. Hears as well as ever ; H. D. 20-20. No medicine. 
 
 March 11, 1879. Has been well until present time. Had 
 slight ear-ache on the night of the 7th inst., and the left ear 
 is discharging ; H. D. right, 20-20 ; left, 6-240 ; pus in canal ; 
 Mt. infiltrated ; tissues of the naso-pharynx much as on the 
 previous visits. Mcrcurius viv. 
 
 ]\Iarch 13. 3*Iuch better; discharge less; H. D. 17-240; 
 Politzer, then 46-240 ; pus in canal ; appearance the same ; 
 remedies the same. 
 
 March 15. More pain; soreness of canal; furuncle in the 
 left meatus ; Mt. not seen. Picric acid. 
 
 ]\Iarch 22. Nearly well ; scales in the meatus, which 
 being removed, showed slight accumulation of pus on Mt. 
 Mcrcurius viv. 
 
 March 25. As well as usual; H. D. 42-240; Politzer, then 
 6-20 ; tissues of canal and drum-head dry. Continue mcrcu- 
 rius viv. 
 
 April 12. Has continued to improve, and to-day reports 
 himself well; H. D. right, 20-20; left, 16-20; Politzer, then 
 right and left, 20-20. Mcrcurius protoiod., which is all he has 
 had since the last date. 
 
 May 5. Found the left meatus wet, without previous pain 
 in the ear; H. D. 16-20; left meatus moist ; Mt. sodden, and 
 re-covered with exudation. Mcrcuriiis protoiod. 
 
 May 10. The tissues have been kept dry, and the condi- 
 tion has improved very much ; soreness below the ear felt on 
 pressure back of ramus of the jaw; tissues of the meatus 
 dry, and Mt. dry. Mcrcurius viv. 
 
 May 12. Pain last night; discharge again this morning; 
 appearance the same as on the fifth. Bclladouua and mcr- 
 curius. 
 
Il8 LECTURES ON CLINICAL OTOLOGY. 
 
 This attack continued until June 4, and was relieved by 
 belladonna and niercurins, and terminated by the formation 
 of a furuncle in the left meatus, which cleared up under 
 Jiepar sitlpJi. calc. 
 
 This case illustrates the tendency of middle-ear disease to 
 become chronic after scarlet-fever, and also the fact that fur- 
 uncle is a frequent complication of middle-ear disease. 
 
 Cicatrices. — Mrs. B. M. A., aged thirty years. Jan. 19, 
 1880. Sixteen years ago had an abscess in the right ear, 
 and recently has had severe pain in the affected ear ; H. D. 
 20-20 ; meatus normal ; membrana tympani is scarred, and, 
 in the posterior inferior quadrant, the outlines of an old per- 
 foration are easily distinguished. This perforation does not 
 present the appearance usual when the mucous membrane 
 of the tympanic cavity is exposed. On exhausting the air 
 of the canal with Siegel's otoscope in position, a thin mem- 
 branous structure is drawn outward into the canal, forming a 
 sac-like protrusion, like bullae. On forcing air into the canal, 
 this same membranous growth is forced through the mem- 
 brane into the cavity of the tympanum. There is no evi- 
 dence of any acute inflammation. Aco7iite given for the 
 neuralgic symptoms. 
 
 April 16. The same condition; sensitive about the ear 
 externally. Hepar sulpJi. calc. relieved this. 
 
 Master Jacob P. K., aged fifteen years. Otitis media snp- 
 pnrativa chronica. April 26, 1881. Over twelve years ago 
 he had scarlet-fever and suppuration ; both ears inflamed ; 
 no pain, but subjective noises ; H. D. R. 10-240, L. contact 
 240 ; auricle normal ; pus in meatus ; Eustachian tube dila- 
 table ; R. Mt. granular, and L. perforated ; pharynx thick. 
 Put on calcarea sidpJi. He continued to improve till Oct. 
 7, when the granulations had disappeared from the right 
 meatus ; and, to my surprise, remnants of Mt. were gradually 
 defined, as it separated itself from the labyrinthian wall of 
 the tympanum. A cotton pellet was applied to the perfora- 
 tion on the left side. 
 
 From Sept. 2 to Dec. 27, the patient was on kali muriaticnm^ 
 
DISEASES OE MIDDLE EAR. — CASES. IK) 
 
 with occasional applications of boracic acid trituration. My 
 record shows, that, at the time, R. Mt. was fair, but adherent, 
 the left perforation closed by a cotton pellet ; H. D. R. 20- 
 20, L. 6-20. 
 
 This patient was sent me by Dr. Samuel Lilenthal, who 
 had induced him to undertake the treatment, notwithstanding 
 an unfavorable prognosis from many persons with whom he 
 had advised. 
 
 Language would fail to give a clear picture of the mental 
 and physical contrast between the two dates, April 26, 188 1, 
 and Dec. 27, 1881. 
 
 Miss S. L. M., aged eight years. Otitis media suppurativa 
 chronica. Jan. 3, 1880. Five years ago had scarlet-fever, 
 and, after the scarlet-fever, mastoid disease. Has had diph- 
 theria recently, which has aggravated the suppurative disease 
 of the ear, and involved the nares on both sides, extendmg 
 forward so that the mucous membrane was ulcerated at 
 the anterior openings; H. D. R. 20-20, L. 1-240; the left 
 meatus was filled with pus ; the left Mt. had a large perfora- 
 tion ; pharynx obstructed by hypertrophied tonsils ; the odor 
 of pus was such that, at first, I gave psorijiuni, and afterward 
 followed it by silicea. I made local applications of calendula 
 glycerole, on absorbent cotton, through the nares into the 
 pharynx : this was continued for about six weeks, when the 
 mucous membrane was healed, and the patient could breathe 
 with perfect ease through the nose. She was under observa- 
 tion until June 11, 1881, when the same secretion of the 
 tympanic mucous membrane was more mucoid than purulent, 
 and was free from bad odor ; H. D. 6-20. During the latter 
 part of the treatment, the remedies were calcarea sidph.^ 
 kali phos., and silicea, with an occasional dose of psorimnn as 
 an intercurrent remedy. The results reached were extremely 
 satisfactory to both parents and surgeon. One interesting 
 feature of this case was, the complete mental transformation 
 of the little patient, within two months from the time the 
 treatment was instituted. At the outset, the parents had 
 been compelled to remove her from school : she was stupid, 
 
120 ' LECTURES ON CLINICAL OTOLOGY. 
 
 morose, devoid of interest in things which ordinarily occupy 
 a child of her age. She became one of the most active 
 scholars of her class, and was the subject of early promotion 
 in her studies. Language does not convey any idea of the 
 picture which such a patient presents. 
 
 Master A. O., aged twelve years. Otitis media suppurativa 
 chronica. Oct. 2, 1873. Had- scarlet-fever in childhood ; after 
 the scarlet-fever, had the first discharge of blood and pus 
 from both canals ; ulceration with granulations at the inner 
 third of the canal ; right membrane perforated ; membrane 
 of the naso-pharynx catarrhal ; H. D. R. 7-240, L. 9-240. 
 Under capsicum, to relieve the pain in the region of mastoid, 
 and calcarea iod., for the condition of the tissues ; hearing 
 improved ; the tissues about the Mt. became more and more 
 clearly defined, and H. D. rose to 6-20 right and left ; but 
 the parents could not be convinced of the necessity of con- 
 tinuing the treatment until the suppurative process could.be 
 entirely overcome. 
 
 A. H., aged eight months. Otitis media sttppurativa 
 chronica. April 6, 1877. Since two months of age, she had 
 running from the ears ; is a very feeble child ; pus in both 
 canals ; watery. Psorinnm, a dose every night. 
 
 April 13. Very much better; right meatus clear; left, 
 moist. 
 
 April 24. Nearly well; more mucus than pus in left 
 canal. 
 
 May II. Has been vaccinated, and, since that, the secre- 
 tion is very much worse. Psoriniim. 
 
 May 22. Better again. In the right meatus, cerumen has 
 secreted ; from the left, discharge of more mucus than pus. 
 
 June 23. Report by letter states that the right ear dis- 
 charges much less, that the left ear discharges none. 
 
 Feb. 7, 1882. Right canal normal ; in the left canal, pus 
 and shreds, which being rem.oved, showed perforation in Mt. 
 Trituration of boracic acid applied locally, psorinnm internally. 
 
 Feb. 23. A perforation clearly defined and moist ; more 
 mucus than pus. Blepharitis ciliaris chronica. 
 
DISEASES OF MIDDLE EAR. — CASES. 121 
 
 At a later interview, the mother stated that the child re- 
 mained well, with the exception, of course, that the perfora- 
 tion did not heal. I may add that the father died quite 
 recently of Bright's disease. 
 
 Mr. W. H. H. B. Otitis media suppurativa chronica. Jan. 
 10, 1873. Has suffered from abscesses in his ears all his 
 life ; complains of noises in his ears, with loss of hearing ; 
 right meatus, pus in the inner half ; left meatus dry ; large 
 perforations in both drum-heads ; granular pharyngitis ; H. 
 D. right, 3-240; left, 1-240; after inflation, 6-240 and 2-240. 
 Under baryta vuir. and agariciLS for spasmodic action of the 
 pharyngeal muscles, and psorimim and silicca for the sup- 
 puration. He improved, so that H. D. was 25-240 right, and 
 20-240 left, and for the voice greatly improved ; suppuration 
 ceased. 
 
 Master A. E. B., aged three and one-half years. Otitis 
 media suppurativa chronica. Nov. 8, 1880. Four weeks ago, 
 had scarlet-fever ; both ears suppurating, both canals filled 
 with pus of a dark, fetid character. Kali pJios. Under this 
 remedy until Dec. 2, when both canals were free, both drum- 
 heads healed ; H. D,, as far as I can judge in a child of his 
 age, was normal. 
 
 April 18, 1881. Has had no trouble since last date; 
 meatus clear ; both drum-heads clear ; but elaps cor. was pre- 
 scribed for naso-pharyngeal symptoms. 
 
 Mr. E. G. B. Otitis media suppurativa cJironica. Oct. 29, 
 1877. Had scarlet-fever when a child, and the left ear has 
 troubled him ever since ; now the right fails. He had ma- 
 laria in adult life, and took massive doses of quinine. H. D. 
 right, 1-20 ; left, 3-240 ; meatus normal ; right Mt. adherent ; 
 left, ulcerative ; tissues defined ; naso-pharyngeal catarrh ; 
 granular pharyngitis. Under treatment until Jan 22, 1878. 
 Under the action of mercurins dulcis and kali bichrom., H. D. 
 rose in right to 10-20; left, 1-20; Eustachian tube dilatable; 
 left drum-head free from pus, but lustreless and thick ; naso- 
 pharyngeal condition much improved. 
 
 December, 1878. Same condition threatened. H. D. fell to 
 
122 LECTURES ON CLINICAL OTOLOGY.'. 
 
 right, 30-240 ; left, 2-240. Under the same remedies, the 
 hearing improved. 
 
 April 7. H. D. right, 10-20; left, 12-240; Eustachian 
 tube clear. This case illustrates the necessity of attention 
 to these patients during the winter, when, from atmospheric 
 conditions, there is liability of relapse. 
 
 Mr. E. A. Otitis media suppurativa cJironica. Feb. 2, 1875. 
 Has had suppurative disease all his life. In left drum-head 
 extensive perforation ; H. D. 6-240. Under hcpar sitlph.y 
 almnen iistimt, kali bichrom., change in the character of the 
 pus, first, a larger proportion of mucus ; and, under kali 
 bicJirom.^ a cessation, even of the mucous discharge, was 
 secured within a year. 
 
 Dec. 24, 1 88 1. This gentleman brought his little grand- 
 son to me for treatment ; and, at my solicitation, he allowed 
 me to apply a cotton pellet to the left ear, with the hope of 
 increasing the hearing. The next day suppuration set in, 
 caused, the gentleman believed, by the pellet. Under feiTuin 
 and calcarea sulph., suppuration was speedily checked. 
 
 Dec. 27. I gave kali mit7\ for the naso-pharyngeal catarrh. 
 
 Jan. 10, 1882. A perforation, which occupied a large por- 
 tion of the posterior inferior quadrant, extending on to the 
 anterior inferior, was entirely free of congestion, but ex- 
 tremely sensitive to touch. The patient declined any further 
 manipulation. 
 
 Mr. I. W. C, aged forty years. Otitis media suppiwativa 
 cJironica. (Consequences.) Feb. 3, 1879. Has had trouble for 
 many years, the causes of which were so early in life that he 
 is not able to explain them. He has had advice previously, but 
 no hope of improvement in his condition. H. D. right, 2-240 ; 
 left, 34-240 ; meatus normal ; right Mt. perforated anteriorly; 
 left Mt. perforated posteriorly ; walls of pharynx thick, red, 
 crypts filled with cheesy accumulations ; Eustachian tube dila- 
 table. Protoiodide of merciuy. Was on this remedy until 
 April 16, when H. D., before inflation, was 12-20 right and 
 left ; after inflation by Politzer's method, 16-20 right and left. 
 
 April 30. He has been on baryta mur. since previous date, 
 
DISEASES OF MIDDLE EAR. — CASES. 1 23 
 
 this remedy being given for movements felt in the tympanum 
 during the act of deglutition; H. D. before inflation, 14-20; 
 afterwards, 18-20. 
 
 Jan. 14, 1880. He has suffered an accident, having had 
 his foot crushed, which prostrated him ; and he relapsed in 
 every condition, so that H. D. right was 6-20 ; left, 4-20. 
 
 Jan, 28. \JndQr protoiodide of mercury, H. D. rose at once 
 to 10-20, which he said was, for all practical purposes, suffi- 
 cient ; as the hearing for the voice was much superior to the 
 test as given by the watch. 
 
 Mr. George C. S., aged forty-five years. Otitis media sup- 
 purativa cJironica. Nov. 3, 1880. There is a history of 
 suppuration from childhood. For about three weeks has had 
 a slight discharge from the right ear; H. D. right, 18-20; 
 left, 8-240 ; the left Mt. is perforated in the posterior inferior 
 quadrant, the edges of the perforations being thick ; there is 
 granular pharyngitis ; Eustachian tube dilatable. Applied a 
 cotton pellet ; then H. D. was 14-240. 
 
 Nov. 6. Tendency to exuberant granulations. Kali mitr. 
 internally and externally. 
 
 Nov. 10. Improved. 
 
 Nov. 20. Very much improved ; very little pus. 
 
 Dec. 3. No discharge ; right ear irritable ; washing out 
 debris, and drying, relieved the irritation. Kali mur. inter- 
 nally. 
 
 Oct. 6, 1 88 1. Has had no difificulty until present date; 
 now the right ear is inflamed ; has slight pain, and the meatus 
 has been moist ; Mt. not perforated. Feii'urn pJios. 
 
 Oct. 7. Tissues very tender ; appearances the same. Fer- 
 rum phos. ; in case of pain, Jiepar sulph. 
 
 Oct. 10. About the same. 
 
 Oct. 18. Right Mt. perforated; free discharge of pus. 
 Kali mur. 
 
 Oct. 25. Adjusted pellet to the perforation. Continued 
 the same remedy. 
 
 Oct. 31. Perforation healed. Applied pellet to the per- 
 foration on left Mt. 
 
124 LECTURES ON CLEVICAL OTOLOGY. 
 
 I have seen the gentleman frequently up to this time 
 (June, 1883), and he has had no difficulty si?ice last date. 
 
 Miss L. M., aged sixteen years. Otitis media sjLppin^ativa 
 c/uvniea. May 12, 1879. Right ear has suppurated occa- 
 sionally for many years, usually after a head-cold ; right 
 meatus filled with pus. On drying the tissues, right Mt. is 
 found perforated ; the pus secretion is watery and fetid. 
 Psorinuin. 
 
 May 19, Much improved; less pus; perforation the same. 
 
 May 26. Suppuration ceased ; tissues of the canal dry ; 
 perforation healed ; pharynx red, granular. Merciti'iits didc. 
 
 May 31. Condition the same; Eustachian tube closed; 
 hearing not improved ; H. D. right, 5-240 ; after inflation, 
 right, 7-240; left, 18-20. 
 
 June 7. No special gain for the voice ; appearance the 
 same ; H. D. right, 24-240 ; left, 16-20; after inflation, right, 
 3-20 ; left, 20-20 ; Eustachian tubes dilatable. Same remedy. 
 
 June 16. Much improved; right, 8-20; left, 20-20. 
 
 June 21. Slight improvement; H. D. right, 12-20. 
 
 July 2. H. D. 20-20 right and left ; right Mt. clearer than 
 left. 
 
 Mr. J. Q. A. R., aged fifty years. Polypus. Action of cal- 
 carea carb. March 26, 1872. Had scarlet-fever when a 
 child ; right ear involved ; almost constant discharge ; had 
 a polypus which was removed eight years ago , now worse , 
 H. D. right, minus ; left, normal ; in the right meatus a 
 broad-based polypus pedicle attached above. Was put on 
 calcarea carb 
 
 April 6. Ear feels better ; less discharge of pus ; is sleepy 
 during the day, and sleepless at night, and insists that this 
 is due to the medicine. This remedy was given at intervals 
 until Aug. 13. The discharge nearly ceased, was slightly 
 bloody, and examination from time to time showed a gradual 
 recedence of the growth, and at this date it is nearly gone. 
 Mt. clear below, the upper part hidden by remains of the 
 granulating mass ; H. D. 20-240 ; after inflation, 24-240. 
 
 Aug. 13. Was put on merciirius viv. 
 
DISEASES OF MIDDLE EAR. — CASES. 1 25 
 
 Aug. 22. Ear sore to touch. The growth is much smaller, 
 only the base of the growth remained attached to the roof 
 near the upper edge of the tympanum ; tissues very sensi- 
 tive ; a probe covered with cotton could not be tolerated for 
 an instant ; H. D. after inflation, 26-240. 
 
 Aug. 27. Sensation in the ear as if something needed to 
 be removed. Examination showed a small point on the upper 
 edge of J//., where five days ago there was only a broad base 
 of gray, ragged tissue, very sensitive to touch ; H. D. after 
 inflation, 32-240. Calcarca curb. 
 
 Sept. 14. Better; growth much smaller; still very sore ; 
 H. D. the same ; discharge excessive. 
 
 Sept. 23. Growth larger ; has taken cold ; hears contact 
 240. Calcarea carb., locally and internally. 
 
 May 16, 1873. Two small granular masses, easily moved, 
 on the upper wall of the canal near Mt. ; on cleansing the 
 canal, the lower portion of the membrane is seen ; tissues not 
 clearly defined ; H. D. an inch and a half for a watch heard 
 twenty feet ; after inflation, 5-240. Calcarea iod. 
 
 May 24. Better ; appearance much the same. 
 
 June 2. A number of small granulated tumors, both an- 
 teriorly and posteriorly to the head of the manubrium ; H. D. 
 3-240; after inflation, 5-240. 
 
 June 10. Granulations small; less pus; H. D. 6-240. 
 Continue the same remedy. 
 
 June 19. Granulations receding, canal more open. Same 
 remedy. This remedy was continued until Nov. 4, when 
 there was a very light discharge : the granulations, which 
 had been excessive, but never amounting to a polypoid form, 
 had decreased very much ; and the patient was so well satis- 
 fied with the improved condition, that he could not be in- 
 duced to continue the treatment. 
 
 At first I did not accept the statement of the patient as 
 regards the action of the remedy in the matter of causing 
 sleepiness, but was satisfied by repeated experiments that he 
 was peculiarly susceptible to the action of the remedy. The 
 substitution of a placebo^ and, later, the administration of 
 
126 LECTURES QN CLINICAL OTOLOGY. 
 
 calcarea^ reproduced the condition so that he insisted that 
 he could not keep awake during the day and about his work, 
 as a hotel steward, when under the action of the remedy. 
 In this respect the case is unique. 
 
 Master Albert A. S., aged thirteen years. Polypus. Ac- 
 tion of alcohol. May 7, 1881. Two weeks ago noticed a 
 bad smell from his ear. Professor F. S. Bradford, M.D., has 
 treated the case, and now sends him to me. Last summer 
 had ear-ache, and was deaf for a time; no pain recently; 
 dark-colored discharge ; polypus in right meatus externus. 
 Alcohol instilled into the canal. Kali phos. internally. 
 
 May 14. Much improved ; polypus shrivelled, easily re- 
 moved with forceps. Continue remedy. 
 
 May 21. Tissues dry ; instilled fluid /^/r<?/^^/;;2. Continue 
 remedy. 
 
 May 28. Reports himself all right ; tissues are dry, and 
 free from shreds. Continue the remedy. 
 
 Sept. 9, 1882. Right ear feels stuffed ; again full of white 
 shreds. These are removed by syringing ; tissues dry. Kali 
 phos. 
 
 Sept. 16. Much improved; shreds less; no discharge. 
 
 Sept. 30. He has improved. On removing the detritus 
 from the canal, I found fine granulations on Mt. Kali miir. 
 This remedy was continued until Oct. 28, when he reported 
 himself all right again. BoTacic acid was dusted over the 
 granulations. 
 
 Nov. II. Slight moisture. 
 
 Nov. 25. Tissues dry and scaling. Kali nnir. Since that 
 time the patient has been seen, and remains well. 
 
 Mr. William E., aged thirty years. Polypus removed by 
 ■torsion. Dec. 7, 1872. No history of early trouble of serious 
 nature. Last August, ear-ache from cold, probably aggra- 
 vated by habit of picking the canal. Since then, discharge 
 of watery matter, sometimes bloody; H. D. right, 18-20; 
 left, contact; from the right meatus, hard cerumen is re- 
 moved, then H. D. is 20-20; left meatus filled with a cellular 
 .polypus. Calcarea carb. 
 
DISEASES OF MIDDLE EAR. — CASES. 1 2/ 
 
 Dec. 13. Same appearance ; freer discharge. 
 
 Jan. 7 and 31. Same remedy sent by letter, as the patient 
 was a commercial traveller. 
 
 Feb. 14. H. D. right, 12-20; after inflation, 16-20; polypus 
 bleeds easily ; discharge freer, dark and offensive. Mcrciirius. 
 
 Feb. 18. Better; discharge changed to a whitish color; 
 the appearance of the polypus is less cellular. 
 
 March 17. Growth filled the meatus nearly to the orifice, 
 and was removed by twisting on the pedicle until torsion 
 removed the entire mass. The bleeding was excessive. 
 Calcarea carb. 
 
 March 19. The base of the pedicle only remains ; H. D. 
 six inches before inflation by Politzer's method, then seven 
 inches. No hemorrhage. Calcarea carb, 
 
 March 24. Less discharge ; somewhat fetid. 
 
 March 27. Only base of polypus remains; after cleansing, 
 H. D. 18-240. 
 
 March 30. Tissues dry ; small prominence where the poly- 
 pus was attached; H. D. 7-240; after inflation, 10-240. 
 
 April 30. No discharge since last date; H. D. right, 18- 
 20; left, 18-240; after inflation, 28-240; the ulcer left by 
 the attachment of the polypus covered with dry secretion. 
 Silicea. 
 
 May 5. Had the same remedy; H. D. 21-240; after in- 
 flation, 30-240. 
 
 June 13. H. D. right, 20-20; left, 9-240; after inflation, 
 1-20; Mt. dry, and clear of crust, but dull and thick in ap- 
 pearance. 
 
 Miss M. L. B., aged forty years. Polypus cured by kali 
 bicJirom. Sept. 21, 1878. Has had catarrhal trouble in her ear 
 for nine months ; slight pain, then discharge ; H. D. 5-240 ; 
 perforation of membrane in anterior inferior quadrant with 
 polypus, the attachment of which is uncertain ; discharge 
 of blood and pus ; polypus bleeds easily when touched with 
 the probe ; the tissues are extremely sensitive, for which she 
 received hepar sulph. The polypus was touched with satu- 
 rated solution of the bichromate of potash and water, under 
 the action of which the growth disappeared in a few weeks. 
 
128 LECTURES ON CLINICAL OTOLOGY. 
 
 Feb. 22, 1879. H. D. 8-20; the only complaint is of a 
 subjective sound, like boiling water. 
 
 1880. In March she had a slight pain for one day, for 
 which she received liepar siilpJi. 
 
 I have heard from the lady through another patient, whom 
 she sent to me, that she remained well since last date. 
 
 Miss C, aged about thirty years. Polypus. Calcarea iod. 
 Feb. 6, 1874. Has had trouble with her left ear for six 
 years ; cause unknown ; no particular subjective symptoms, 
 but the annoyance of a constant discharge ; left meatus filled 
 with granular polypus. Calcarea iod. internally, and the 
 growth was destroyed by electrolysis. It returned in about 
 three years, and calcarea iod. was given again. The canal 
 was syringed with a solution of alcohol and boracic acid, and 
 horacic acid trituration was used in conjunction with calcarea 
 iod. She has had one relapse, due to an acute coryza, which 
 was at once relieved by the same remedies internally, and 
 the same local measures ; no return of granulations. 
 
 Jane C, aged seven years. Polypus. Sept. 16, 1878. 
 She has had a discharge from the left ear for three weeks ; 
 had diphtheria and malaria ; extremely prostrated ; left mea- 
 tus is filled with pus ; inner third of Mt. granular, and the 
 tissues undefined. She was put on baryta miw. for subjec- 
 tive sounds, on swallowing, and for glandular enlargement. 
 
 Oct. 7. Both ears have discharged ; the pus is less, and 
 crusts have formed over the ulceration. Silicea. 
 
 Feb. 5, 1879. The right ear discharges, and the pus is 
 very offensive ; on examination, a polypus is discovered in 
 the right meatus ; this was very soft, cellular, and easily 
 removed by forceps. Psorimmi internally, and alumen tistiLin 
 locally. 
 
 Feb. 28. Another polypus had grown in the mean time, 
 even larger than the previous one, but of the same nature, 
 and was easily removed ; profuse hemorrhage followed. 
 
 April 14, 1880. Has remained well since last date, but 
 now has recently relapsed ; in the right meatus, pus, and 
 shreds of tissue. Psorimiin and silicea. There were small, 
 
DISEASES OE MIDDLE EAR. — CASES. 1 29 
 
 scabby sores on the scalp in various spots posteriorly, and 
 the complaint of itching over the whole body. 
 
 April 20. Very much better ; very little pus ; left Mt. 
 perforated ; mucus was forced through the perforation by m- 
 flation. Psoinnum and zinciim. 
 
 The mother of this child sent another patient to me for 
 treatment, who reported a perfect cure of the girl. 
 
 Mr. R. W. R., aged twenty-five years. Otitis media sup- 
 purativa chronica with polypus. Feb. 8, 1876. For three 
 years and a half has had abscesses in ears, first in the right, 
 then in the left; H. D. right, contact 20; left, 3-240; walls 
 of canal scaly ; right Mt. irregular and granular ; left Mt. 
 irregular and dry ; tissues of the wall of the pharynx thick 
 and deep red. Mcrcuriiis dulc. 
 
 March 15. Has made weekly visits ; H. D. right, 6-240; 
 left, 30-240. Continued under treatment about one year, 
 when H. D. right was 10-240; left, 4-20. The right was still 
 granular. He then passed from under my treatment, and 
 was for four years in the hands of a so-called ''regular" 
 specialist. 
 
 June 27, 1 88 1. He has had severe pain in the right ear, 
 and returns to me for attention. The pain has been relieved 
 by hot applications. The canal is filled with pus ; Mt. ulcer- 
 ated over its whole extent ; discharge dark and offensive. 
 Kali phos. He was on this remedy till July 8, when he was 
 very much improved ; the tissues were clearer, and more de- 
 fined. Under kali phos. he made steady improvement until 
 Oct. 20, when exhaustion with Siegel's otoscope moved the 
 Mt. to its full extent ; the tympana were dilatable. 
 
 Nov. 7. A small polypoid mass was discovered encroach- 
 ing on the canal from above, soft, easily crushed and re- 
 moved ; very free from hemorrhage on its removal. Kali 
 chloridum was given internally, and the hemorrhage was 
 checked by absorbent cotton. 
 
 Nov. 26. No discharge, and the tissues are perfectly dry. 
 The patient continued to improve under kali cJdoridum with 
 mercurius dulc. for acute conditions through the spring of 
 1882, since which time he has not returned for treatment. 
 
130 LECTURES ON CLEXTCAL OTOLOGY. 
 
 Mr. J. H. K., aged thirty-five years. Otitis media suppura- 
 tiva chronica ivith polypus. April 23, 1880. Has had trouble 
 with his right ear since childhood ; constant discharge of 
 pus, but no particular subjective symptoms; the meatus is 
 filled with pus. On drying the canal, a polypus is found 
 covering the entire field. The patient was very timid, and 
 objected to its removal. Was put on kali pJios., with local 
 applications of the trituration of sa7iguinaria nit. The 
 growth receded for a time, but during the vacation between 
 July and October it became very much larger ; and on hi^ 
 return he was put on kali niur., with local applications of 
 boracic acid, which checked the growth, and it was easily 
 removed with Sexton's forceps by piecemeal. The kali mur. 
 was continued. 
 
 Dec. 22. There was no further discharge. The patient 
 was put on silicca to heal the ulcer which remained at the 
 seat of the attachment of the pedicle. 
 
 The patient remained in good condition until March, 
 when, on contracting a head-cold, granulations were observed 
 in the left side, and there was a slight discharge of pus. He 
 was put on kali mur. with hepar siclph. at one time for ex- 
 treme sensitiveness of the tissues. 
 
 April 8. The ulceration has healed. 
 
 May II. A relapse again from a head-cold; tissues moist 
 and granular. 
 
 June 6. Has been on same remedies to date, and is much 
 better. 
 
 July 21. Another relapse; tissues more moist; perfora- 
 tions where the granulations had been. 
 
 Oct. 8. Has been only fairly well ; tissues moist ; perfo- 
 rations the same ; head-ache over the right side of the head 
 and temples. Calcarea sulpJi. 
 
 Oct. 22. Has continued to improve ; the perforations are 
 healed ; a simple spot remains on the upper edge of the Mt. 
 'The tissues remained well until the 28th of June, 1882, when 
 a gland below the auricle, at the ramus of the inferior maxil- 
 lary, enlarged and suppurated. He was put on Jiepar sidph., 
 
DISEASES OF MIDDLE EAR. — CASES. I3I 
 
 and the abscess opened ; there was a free discharge of pus, 
 which entirely reheved the local trouble ; the Mt. was in the 
 same condition as at the previous visit. 
 
 June, 1883. I have recently seen this patient, and he 
 reports that he has remained well since last date. 
 
 Case No. 5. — Alonzo Ames, aged forty-one. Otitis media 
 siipptirativa chronica. Oct. 19. Has been the subject of 
 catarrhal condition of the throat for about three years and a 
 half. Now complains of acute conditions resulting from con- 
 tracting a cold. Since that exposure, there is an aggravated 
 condition of the naso-pharynx and ear. This is similar to 
 Case No. 2. An acute condition has arisen in connection with 
 previous history of suppurative disease of the middle ear ; 
 and there is nothing of special interest to note concerning it, 
 in contrast to No. 2. It is well, however, to examine each 
 case, comparing it with other cases of the same form of dis- 
 ease. In fact, I cannot urge too strongly upon you the 
 practice of frequent examination of the cases which you may 
 have the opportunity to observe. It is only in this way you 
 will be able to recognize, in similar cases, those differences 
 which are very often very important in the selection of the 
 remedy. In this case, the sensitiveness of the tissues sug- 
 gested the use of hepar siilph. calc, which was given every 
 two hours during the day. Belladonna, a solution in water, 
 was given every half-hour in the evening and night, when the 
 symptoms of pain are more marked. This treatment has 
 been the means of great relief. The patient will be directed 
 to present himself again, that we may determine what reme- 
 dies may be required after the acute symptoms have abated. 
 
 Case No. 4. — Garmore Pratt, aged thirty years. Otitis 
 media suppurativa chronica. The history of this case is not 
 clear. Some time since, he was attacked by suppurative in- 
 flammation of the middle ear, resulting in perforation of the 
 membrana tympani. He was furnished with an artificial 
 membrane, purchased from parties who supply these instru- 
 ments without any regard to the condition of the patient or 
 the results which follow their use. In this, the artificial mem- 
 
132 LECTURES ON CLINICAL OTOLOGY. 
 
 brane produced harm, causing a constant irritation and in- 
 creased discharge. Coming under our care, he was directed 
 to remove it. Suppuration ceased ; and the cotton pellet was 
 substituted, which does not cause any irritation, and gives 
 better results as regards hearing than any artificial membrane 
 possibly can do. In cases of perforations of the membrana 
 tympani, the ossicula are found out of position, and vibra- 
 tions of the air are not communicated to the stapes in full 
 force. The application of the cotton pellet brings the ossi- 
 cula more nearly into their normal position, and retains them 
 there, so that the hearing-power is increased to a very great 
 extent in some cases. I have in mind the case of a little 
 girl, in whom the application of the cotton pellet increased 
 the hearing-power for the watch threefold, and for the human 
 voice the gain was much more marked. I will mention, in 
 this connection, a case which interested me very much. 
 The subject was the father of a little patient whom he 
 brought to me for treatment of suppurative disease. He 
 casually mentioned the fact of his own affliction, and showed 
 to me that he had been in the practice of applying a roll of 
 cotton in the ear, in such a way that it rested upon the floor 
 of the canal, and against the drum-head, closing a perforation, 
 and increasing his hearing-power in a very slight degree. I 
 applied a cotton pellet, which the patient removed, finding 
 that he could adjust the roll of cotton so that it served a 
 much better purpose. 
 
 Case No. 2. — Horace Trumbull, aged sixty-eight. Otitis 
 media sitppiirativa cJironica. Aug. 28. For six weeks has 
 suffered pain. He was affected a few years previously : for 
 the last two years he has been subject to hemorrhage from 
 the nose. The present condition began with itching in the 
 ears : he took a salt-water bath ; and there resulted an inflam- 
 matory action of the left ear, severe pain, burning, and, finally, 
 a discharge. This is an acute condition occurring in a chronic 
 suppurative case. There has been prevalent among the laity 
 the impression that a discharge from the ear is good, and 
 that, so long as it continues, there is no need of alarm, but, 
 
DISEASES OF MIDDLE EAR. — CASES. 1 33 
 
 if checked, it will be followed by serious results. This error 
 has been re-enforced, in some cases, by the opinion expressed, 
 and the advice given, by medical men who have not recog- 
 nized the difference between the effects of disease external 
 to the drum-head, and disease of the middle ear, which has, 
 in some cases, been suppressed by improper local applica- 
 tions. Examination of this case shows the meatus to be 
 filled with pus, removal of which exposes the membrane, 
 more or less disorganized by previous inflammatory action. 
 It is impossible to determine whether the membrana tympani 
 is perforated or not, because of the closure of the Eustachian 
 tube on that side. The patient is not suffering excessive 
 pain, and there is no evidence of general constitutional dis- 
 turbance. We will give calcarea phos.^ and dust the surface 
 with a trituration of boracic acid. 
 
 Sept. 4. The patient was relieved at once ; suppuration 
 ceased to-day ; the membrana tympani is dry, irregular, and 
 retracted ; the Eustachian tube on that side still closed. 
 Kali miir. 
 
 Mrs. A. H. B. Mastoid disease. Dec. 23, 1878. Since 
 six weeks, had suffered pain in the left ear. Poultices were 
 ordered, and continued for five weeks. Now the ear is full 
 of pus, drum-head hidden, Eustachian tube closed ; mastoid 
 process swollen ; directed to abandon the use of poultices, 
 and simply keep the head wrapped with warm cotton over 
 the affected ear. Capsicinn in solution every two hours. 
 
 Dec. 26. Much better. 
 
 Dec. 28. Not so well. Sent to the ''New-York Ophthalmic 
 Hospital :" here she was placed in bed, warm cosmoline was 
 dropped into the meatus, and cotton saturated with cosmoline 
 applied over the mastoid process and auricle, secured in its 
 place by a large cap, which covered the whole head. Capsi- 
 ctmi continued. 
 
 Dec. 29. The swelling and tenderness possibly a little 
 les3, and the discussion of the question of incision postponed 
 one more day. 
 
 Dec. 30. Very much improved ; swelling less ; tenderness 
 less ; pain very much diminished. Continue capsicicm. 
 
134 LECTUREONS CLINICAL OTOLOGY. 
 
 Jan. 15, 1879. Discharged from the "Ophthalmic Hospi- 
 tal" on the nth, having 'made a complete recovery from the 
 mastoid disease. 
 
 Have seen this lady's physician frequently since that date, 
 and understand from him that the recovery was complete, 
 and the hearing restored perfectly, as good as on the other 
 side. 
 
 Cured cases. — Samuel S. Otitis media siLppiirativa chro- 
 nica. June 15, 1880. F'ourteen years ago an insect got in 
 his ear, causing pain for two weeks. By advice, he filled the 
 ear with honey ; and, later, a waxy plug came out. Two years 
 ago, he had another attack of pain, and recovered. May 10, 
 he was treated by Dr. Latimer of Brooklyn for a similar at- 
 tack, and, by his advice, comes to me for treatment. The 
 right meatus is filled by a polypus ; walls of meatus covered 
 with pus, on removal of which the tissue is found hard, dry, 
 smooth, and white. I gave him dilute alcohol, to be dropped 
 in the meatus morning and evening; diwdcalcarea p/ios., to be 
 taken internally. 
 
 June 22. A portion of the mass came away this week. 
 The same treatment. 
 
 June 29. Tenderness of the canal at the outer third ; 
 very slight discharge .of pus during the week ; polypus 
 shrivelled so that it fills only a very small portion of the 
 canal, and can be easily removed. Continue the dilute alco- 
 hol and calcarca phos. 
 
 July 8. The patient remarked, '' I think my ear is all 
 right." In the right ear a perforation of the membrana 
 tympani is seen in its posterior inferior portion. The poly- 
 pus is shrivelled to a mere point. 
 
 This case is quoted to illustrate the effect of alcohol upon 
 granular tissue. I may state, there was no recurrence. 
 
 Mr. John O., aged sixteen years. Mastoid disease. May 
 8, 1880. Has been the subject of chronic naso-pharyngeal 
 catarrh for a number of years. Seven weeks ago, a severe 
 cold caused pam in the left ear. A practitioner of the so- 
 called '' regulaV " school performed paracentesis, not being 
 
DISEASES OF MIDDLE EAR. — CASES. 1 35 
 
 able to relieve the pain with anodynes. A slight discharge 
 followed, but no relief of the pain. The meatus is normal ; 
 the inner third reddened ; the tissues about the drum-head 
 undefined ; hearing, contact-20. Hcpar siilph. every three 
 hours ; belladonna to be given in solution every half-hour, 
 in case of pain. 
 
 May 9. Pain much relieved — only occasional attacks. 
 
 May 10. Much better; itching in the ear; pain only at 
 3.30 A.M. 
 
 May II. Rather better, but no evidence of pus in the 
 cavity of the tympanum. 
 
 May 12. Two heavy perspirations last night; pain set in 
 at 3.45 A.M., and has continued. 
 
 May 13. No relief. Consultation with Dr. C. Th. Liebold, 
 who confirmed the diagnosis, and advised removal to the 
 " Ophthalmic Hospital," on which step I had previously in- 
 sisted. 
 
 . June 5. On last date, the patient entered the hospital, as 
 suggested, and has remained there until to-day. The mas- 
 toid became involved, but, apparently, on its external surface 
 rather than at the antrum, the swelling being above, and on 
 a level with the junction of the auricle with the head, and 
 posteriorly. Upon the determination of pus superiorly, in- 
 cision was made to the bone, and a free exit for blood secured. 
 The bone was denuded over quite an extent, but no sinus 
 could be detected with the probe. Silicca was given, and in 
 two days the denuded bone was covered : the sinus closed 
 from beneath, and healed kindly. The drainage was main- 
 tained until the opening closed spontaneously. 
 
 June 30. Up to this time the patient has had calcarea 
 phos. In general, good condition. The tissues of the drum- 
 head are clearing up, and there is a fair prospect of a good 
 degree of hearing-power. 
 
 Sept. 18. Canal and drum-head as clear on the side that 
 has been affected, as on the other ; hearing scarcely 10-20 
 on each side ; both drum-heads thickened ; the patient the 
 subject of chronic naso-pharyngeal catarrh, which is decid- 
 
136 LECTURES ON CLINICAL OTOLOGY. 
 
 eclly ozsenic ; stricture of the left lachrymal duct. Advised 
 not to think of spending the winter in New-York City. 
 
 Cotton pellet. — Miss A. G., aged eighteen years. Dec. 5, 
 1873. At the age of five years, had suppuration in both 
 ears after scarlet-fever ; meatus, right and left, filled with 
 pus ; tissues on the region of the drum-head undefined ; gran- 
 ulation bleeding easily. The patient had been under old- 
 school treatment, the subject of applications of the nitrate 
 of silver, the granulations being cut out weekly with curved 
 scissors. The patient, under treatment with internal reme- 
 dies, such as calcarea tod., kali bicJi., uterairiiis, silicea, and 
 telhiriiiin, and local application of ahtinen iistiim, improved so, 
 that, by January, 1876, the granulations had disappeared, and 
 a large perforation was distinguished right and left. The 
 patient continued to improve till the fall of 1880, when she 
 was put upon kali 7niii'., under which remedy she has contin- 
 ued, with an occasional prescription of merciLrius, in some 
 form, or Jiepar sitlph. calc., for acute symptoms. Since Febru- 
 ary, 1880, she has had the cotton pellet applied on both sides, 
 whenever occasions have occurred on which it was especially 
 desirable that she should be able to hear more promptly than 
 under ordinary circumstances. On the succeeding days, the 
 pellets would be removed, on account of the suppuration. 
 Since 1881 she has been able to wear the cotton pellet more 
 or -less constantly in the left ear, the right ear suppurating. 
 
 I may add, that since October, 1881, she has improved 
 decidedly by the local use of boracic acid trituration. I now 
 apply the pellet in each ear. 
 
 Miss. A. R., aged nine years and a half. May 15, 1880. 
 When about a year old, had discharge from the left ear dur- 
 ing dentition. Was treated, in 1875, for ulceration of the 
 left ear, which healed under tellurium. At the present date, 
 there remains only the falciform border of the drum-head ; 
 the remains of the manubrium malleus are drawn inwards 
 to the tympanic wall; hears only 12-240; on adjusting the 
 cotton pellet, hears 28-240. 
 
 Feb. 7, 1882. The cotton pellet remains in position; the 
 
DISEASES OF MIDDLE EAR. — CASES. 1 3/ 
 
 patient hears 46-240. A crust of cerumen, mixed with epi- 
 dermis, having accumulated, the pellet was removed ; hears 
 7-240. The pellet replaced, hears 28-240. This case is cited, 
 simply to show the decided improvement in hearing ; though 
 I believe that it is true, that the presence of the cotton pellet 
 acts as a prophylactic measure, because the mucous mem- 
 brane of the tympanic cavity is not exposed to the direct 
 effects of the cold air. 
 
 Case No. J. — Christy Powers, aged 12 years. Otitis media 
 suppurativa chronica. Oct. 12, 1882. Four years ago, this lad 
 was attacked by measles, which left its sequel in the form 
 of a discharge from the left ear ; subsequently, a slight flow 
 from the right ear, followed by deafness. From his own 
 statement, the disease is not associated with pain. The case 
 illustrates the results of exanthemata in the form of measles. 
 The disease began in the naso-pharynx, extended along the 
 Eustachian tube, and involved the middle ear. The mem- 
 brana tympani yielded to the inflammatory action. These dis- 
 charges gave a basis upon which extensive changes have been 
 built up, — changes in the epithelium; later in the deeper 
 tissues, finally resulting in extensive perforations. The right 
 meatus is now filled with granulations, which are very exten- 
 sive, covering the posterior wall, as well as the membrana 
 tympani, so that the relations of the parts cannot be deter- 
 mined. The left ear is in a similar state, but the ulceration 
 is what may be termed indolent. The membrana tympani is 
 perforated, but there is no evidence of exuberant granula- 
 tions. The treatment has both been mechanical and medi- 
 cinal. The first was to overcome the fetor, which marks the 
 suppurative process in many of these cases. To accomplish 
 this, nothing is better than the boracic acid trituration, which 
 may be either fifty per cent or seventy-five per cent tritura- 
 tion with sugar of milk. Whether there be any truth in the 
 theory of micro-organisms, as related to suppurative process, 
 has been seriously questioned ; but one of our famous Ger- 
 man aurists has demonstrated that micro-organisms do exist 
 in the secretions as long as the suppurative process is active, 
 
138 LECTURES ON CLINICAL OTOLOGY. 
 
 and that as soon as the micro-organisms are destroyed, by 
 the use of antiseptic agents, the secretions cease to be 
 suppurative, and most cases hasten to a cure. Mechanical 
 treatment in this case was, to inflate the middle ear, through 
 the Eustachian tube, forcing the drum-head outward towards 
 its normal position, from which it had been pressed inward 
 by atmospheric pressure. Inflation was performed by the 
 use of the Eustachian catheter, through which air is forced, 
 dilating the tube, and throwing the drum-head outward. 
 
 Oct. 26. This case returns to us to-day for examination, 
 to note the improvement. The treatment which was directed 
 on the former day has been continued. The granulations of 
 the right ear are clearing up, and suppuration is much less 
 marked. In this case, I do not think that the change is due 
 to the use. of the boracic acid alone, nor do I think that the 
 internal remedies have done the work exclusively : both 
 means have worked hand in hand. In cases similar to this, 
 I have often followed the suggestion given by some foreign 
 writer, — whose name at this moment I cannot recall, — of 
 using a mixture of alcohol in warm water for syringing the 
 ear in suppurative cases. I have had adjusted for my use an 
 arrangement, which I have never seen suggested by another. 
 It consists of a suitable tip, fitted to an ordinary ear-syringe, 
 such as is fitted to the ear-syringe for a separable nose-syringe. 
 On this tip I adjust the ordinary hard-rubber Eustachian 
 catheter. This enables me to turn the handle to either the 
 right or left side ; and, while the meatus is well illuminated, 
 the beak of the instrument can be passed carefully in, either 
 with or without the speculum, thus bringing the instrument 
 to bear in any direction, and upon all parts of the illuminated 
 surface. Afterwards, the tissues must be perfectly dried, then 
 the boracic acid dusted on, as before suggested. In some 
 cases, it is desirable to avoid the use of the snare for the 
 removal of large granulation masses or fibrous polypi. For 
 this purpose, I have found boracic acid less irritating than 
 bichromate of potash, as suggested by Dr. W. P. Fowler of 
 Rochester. I always have prepared a saturated solution of 
 
DISEASES OF MIDDLE EAR. — CASES. 1 39 
 
 boracic acid in water. I take equal portions of this and 
 common alcohol, and direct the parent, or person having 
 charge of the patient, to drop a few drops, say five, in the 
 ear night and morning, closing the canal with cotton. After 
 a few applications, the growth is checked ; and the application 
 of the dry boracic acid, at the ofhce-visits, is evidently more 
 effective. In a short time, one is able to remove the re- 
 mainder of the mass with ordinary forceps, without disturb- 
 ing the equanimity of the little patient. 
 
 March, 1883. This patient has made rapid progress under 
 kali vmr. and the local treatment. The granulations have 
 entirely disappeared from the right ear. The right membrana 
 tympani is dry, adherent, with deep folds anteriorly and pos- 
 teriorly to the manubrium, and perforated in the anterior 
 inferior quadrant. The left membrana tympani has cleared 
 up, is perforated in the anterior inferior quadrant ; and the 
 cavity of the tympanum is nearly free from purulent prod- 
 ucts under the action of silicea. 
 
 Mr. G. C, aged sixty-two years. Mastoid disease. Jan. 
 II, 1873. He stated, that, thirty-two years ago, he had an 
 ''awful" pain in the left ear; after some time heard as well 
 as ever. Last October took cold ; the left ear pained, finally 
 broke, then healed, and broke a second time ; hearing with 
 right ear, 12-240; left, 2-240; the right meatus narrow, the 
 left filled with fetid pus ; mastoid process sensitive, red, 
 swollen ; whole side of the face aching, a dull ache, at night 
 worse. Capsicum every two hours ; vterciLvius at night, every 
 half-hour, when the pain is aggravated. 
 
 Jan. 22. A large tumor behind the left auricle, displacing 
 the auricle altogether ; less pain ; the meatus full of pus, but 
 no escape from the cavity of the tympanum. Capsicicm in 
 solution every two or three hours during the day. 
 
 Jan. 23. More pain last night, and more discharge ; the 
 .same appearance. Continue capsicum and merciLviiLS as be- 
 fore. 
 
 Jan. 24. A better night ; only discharge from the meatus ; 
 mastoid process less swollen and sensitive. Continue the 
 same remedies. 
 
I40 LECTURES ON CLINICAL OTOLOGY. 
 
 Jan. 27. As the condition was not materially changed, de- 
 cided to make an incision in the mastoid, cutting down to 
 the bone : the knife passed readily into the antrum ; and a 
 free discharge of pus followed, dark, bloody, and very offen- 
 sive. Hepar sidph. The free discharge of pus from the 
 mastoid relieved the pain ; discharge from the meatus freer. 
 CapsiciLin and silicea. 
 
 Feb. I. Less discharge from mastoid process and mea- 
 tus. Continue the same remedies. 
 
 Feb. 3. Only blood flows from the mastoid process, and 
 pus from the canal. 
 
 Feb. 5. Not as well; discharge from the meatus less; dis- 
 charge from the mastoid process increased. Capsicum. 
 
 Feb. 7. More pain at night ; free discharge of blood and 
 lymph from the sinus in the mastoid process, but thick pus 
 from the meatus. Capsicimi through the day, and mercitrms 
 at night. 
 
 Feb. 10. Much better; no pus in meatus ; sensation as of 
 movement in the ear when chewing ; watery discharge from 
 the mastoid process ; pus in the canal. 
 
 Feb. 14. Much better; only one slight attack of pain; 
 tissues of the mastoid process much freer ; watery discharge 
 from both meatus and mastoid process. 
 
 April 14. The same conditions have continued up to this 
 day, with slight but decided improvement. On this date 
 I used the method, suggested by Dr. James Hinton, of for- 
 cing some fluid, by way of the meatus, out through the sinus 
 of the mastoid. For this purpose I covered the tip of the 
 ear-syringe with a section of a rubber tubing, closing the 
 meatus completely, filled the ear-syringe with warm fluid 
 cosmoline, and with steady pressure entered the syringe into 
 the meatus and tympanum. Pus and blood were driven out 
 through the sinus of the mastoid process into the pharynx 
 by the Eustachian tube. A second injection resulted in 
 bringing the fluid petroleum through nearly free from pus. 
 Capsicum. 
 
 April 23. Much better ; Hinton's method continued. 
 Silicea. 
 
SUMMARY OF REMEDIES. I4I 
 
 May 3. Hinton's method has been used thoroughly ; 
 little pus in the canal ; perforation of the drum-head is 
 well defined, and the passage of the fluid petroleum through 
 the sinus is much more free and easy than previously. This 
 method was continued until July 18, until both from the 
 canal and opening in the mastoid the discharge was nearly 
 clear and lymph-like fluid. The patient then complained of 
 severe neuralgia, and disturbance of the stomach and abdomi- 
 nal viscera, so that he became very intolerant of the treat- 
 ment for the ear ; and from that time I lost track of him. 
 
 I learned, after the first notice of the case, that the patient 
 was treated, immediately after the first pain in the ear, by a 
 so-called ''botanic" physician, who ordered large fomenta- 
 tions of herbs applied over the whole side of the head ; and 
 these were changed from hour to hour, and continued from 
 day to day, until the suppuration was established to the 
 degree which existed at the time of his visit to me. From 
 the statement of his daughter, I am satisfied that the exces- 
 sive heat and moisture tended to increase the suppuration, 
 while it did not relieve the pain. 
 
 Summary of Remedies. 
 
 Aconite. — In acute suppuration of the middle ear, or for 
 acute symptoms arising in chronic disease. (See External 
 Ear.) 
 
 Agaricus miLscariiis. — For spasm of pharyngeal and tym- 
 panic muscles ; twitching and rattling or fluttering in the 
 tympanic cavity (R) ; jumping of tensor tympani, with sound 
 as of a leather-covered metal valve ; rolling, twitching in the 
 tympanum ; creaking in both ears on empty swallowing ; at 
 every attempt to swallow, a creaking sound in both ears, as 
 of a wooden screw. 
 
 Aiirum vietalliciim. — This is indicated in consequence of 
 suppurative inflammation of the middle ear. The perios- 
 teum of the temporal bone being affected, the porous diploe 
 yield ; and finally the entire surfaces, external and internal, 
 are denuded. The subjective symptoms, so far as the ear is 
 
142 LECTURES ON CLINICAL OTOLOGY. 
 
 concerned, are decidedly negative ; but the general ones 
 make the choice between this remedy and fluoric acid, nitric 
 acid, or silicea, easy. Pain, like a bruise, or as if pulled, 
 worse at night by uncovering and at rest ; better by motion, 
 by washing, and while sensitive to cold ; yet relieved by 
 going into the open air, even in bad weather. The tis- 
 sues of the Me. are bathed by a fetid pus, the odor being 
 characteristic of necrosed bone. The Mt. is usually per- 
 forated, the ossicula more or less disintegrated and thrown 
 off. Often the osseous meatus is denuded, sinuses connect- 
 ing the canal with the fistulous openings upon the external 
 surface of the mastoid process. 
 
 Baryta miLriatica. — Baryta is one of our most valuable 
 remedies, both in suppurative and non-suppurative inflamma- 
 tion of the middle ear. After frequent failures with the 
 carbonate, we find that the symptoms, as given in Allen's 
 ** Encylopsedia," vol. ii.. Baryta carbonica, — symptom 122, 
 ''hardness of hearing;" 123, ''severe buzzing in the ears;" 
 124, " cracking in both ears when swallowing ; " 125, " crack- 
 ing in one ear when swallowing, as if it were breaking ; " 
 126, "cracking in one ear . . . when swallowing, sneezing, 
 etc. ;" 129, "a reverberation in the ear on blowing the nose 
 violently," — have been repeatedly relieved by the muriate. 
 What is the significance of these symptoms t Dr. Hinton, 
 in his work entitled, "Questions of Aural Surgery," writes, 
 "Mr. Yule confirms the statements of Drs. Jago and Rum- 
 bold respecting the effect of an abnormally open Eustachian 
 tube in intensifying any sounds produced in the patient's 
 own throat ; and I had the opportunity of demonstrating 
 that the cause is rightly assigned, by introducing into his 
 tube a vulcanite Eustachian catheter, in the curve of which 
 an orifice was cut, so as to establish a continuous passage 
 from the throat to within the tube, when the very same 
 effects that result from his own muscular action were pro- 
 duced." Those specially interested in the details of this 
 study are referred to the above-mentioned work.' These 
 
 ^ James Hintcn, The Questions of Aural Surgery, p. 102. London, 1874. 
 
SUMMARY OF REMEDIES. 1 43 
 
 symptoms are, therefore, due to interference with the action 
 of those muscles which open and close the Eustachian tube. 
 We shall have occasion to contrast an abnormally open tube 
 with one closed by morbid conditions. 
 
 Belladonna. — In acute inflammation of the middle ear, or 
 when acute symptoms arise in chronic disease. (See Exter- 
 nal Ear.) 
 
 Calcarea carbonica applies to the same class of patients as 
 in general diseases, — the fat, rapidly growing, large-headed, 
 soft-boned children, or adults who in youth were vigorous, 
 but now fail from low power of assimilation, great weakness, 
 dejection, sensitiveness to cold, damp air. The pains about 
 the head are pressing or pulsating, often semilateral ; cold- 
 ness of the head ; sweat on the head evenings. The pain in 
 the head is also beating, with knocking, buzzing, and roar- 
 ing. Detonation in the ears. Meatus filled with whitish, 
 pappy, fetid pus, or viscid discharge. Membrana tympani 
 perforated, and often the edges are covered with granula- 
 tions which extend to the walls of the meatus : occasionally 
 these enlarge, and form polypi, usually of the mucous, or 
 cellular, variety. We have found these exuberant granula- 
 tions to yield more promptly to the calc. tod. than to the calc. 
 carb. If the growth is large, and cause pressure by check- 
 ing the escape of pus from the tympanum, it should be re- 
 moved by mechanical means ; but this does not prevent its 
 rapid renewal. Silicea should follow the calcarea after the 
 ulceration assumes an indolent type. 
 
 Capsic2un. — For chronic suppuration, in adults especially. 
 The pains in and around the ear are acute, shooting, pressing, 
 with bursting head-ache ; great thirst, with chilliness and shiv- 
 ering. In February, 1872, Dr. T. F. Allen called our atten- 
 tion to this special symptom : " On the petrous bone, behind 
 the ear, a swelling painful to the touch." In April, 1873, we 
 published, in the Ophthalmic Hospital Reports, for the New- 
 York "Journal of Homoeopathy," cases showing its value. 
 Ten years have added many cases to our list of cures : the 
 typical ones are those in which acute symptoms occur in 
 
144 LECTURES ON CLINICAL OTOLOGY. 
 
 chronic cases ; the mastoid cells become involved, and their 
 dense structure yields slowly ; hence the danger of cerebral 
 trouble, as the diploe of the temporal bone above threatens 
 to give way before the petrous portion below and behind. 
 In children, the mastoid cells are large, and, with their walls, 
 break down with comparative ease. Heparsulph. calc. hastens 
 the relief, when the case has advanced far before capsicum is 
 used. In some cases, the swelling behind the auricle has 
 been very great, turning it almost to a right angle with the 
 side of the head, the meatus being closed almost entirely ; 
 the pus is yellow, flowing quite freely, and not especially 
 offensive. In every case the Mt. was perforated. 
 
 Carbo animalis and carbo vegetabilis are found in our reper- 
 tories as curative for otorrhoea ; and one writer states, " sup- 
 puration of the internal ear, and discharge from the same,'' 
 meaning middle ear. Thus far, all the cured cases seen at 
 the clinic and in private practice were those where the lesion 
 was external to the membrana tympani. A review of the 
 year-books confirms our view, that the action of the remedy 
 is curative in chronic non-suppurative inflammation of the 
 middle ear, - — the so-called proliferous form. Objective symp- 
 toms : membrana tympani retracted, opaque in most cases, 
 tympanum dry, the Eustachian tubes easily dilated, the 
 pharynx granular. The subjective symptoms suggest a dry 
 state of tissues, itching and tickling in the ear (similar to the 
 throat-symptoms), with cracking on moving the jaw, an incli- 
 nation to swallow, which relieves the ear. 
 
 Caiisticiim. — There is an absence of objective symptoms 
 in cases cured by causticum, but the subjective ones are very 
 pronounced: "Crawling, as from an insect;" "Itching in 
 the ear, beginning in the throat, along the Eustachian tube." 
 (Also under nitx. voni.) The symptoms under the internal 
 ear are noteworthy. 
 
 Chamoinilla. In acute disease, with the symptoms noted 
 under otitis externa. 
 
 China, or cinchona. — Indicated in suppurative inflamma- 
 tion. After repeated trial of the various remedies given 
 
SUMMARY OF REMEDIES. 1 45 
 
 in our repertories for hemorrhage from the ear, such as 
 cicuta, lac/iesis, nicrcitrius, Pulsatilla, and failing of satisfac- 
 tory results, we gave cJiiiia to a little girl at the clinic of 
 the New-York Ophthalmic Hospital. The following were the 
 objective symptoms : meatus full of sanguineus, sanious dis- 
 charge; the tissues infiltrated, and suggestive of deep-seated 
 disease ; Mt. not seen : the patient was very anaemic ; and 
 the cinchona was given upon general, rather than local, indi- 
 cations To our surprise and delight, the case changed its 
 features at once : the meatus became more open, the mem- 
 brana tympani defined, the perforation clearly so, the flow of 
 blood ceased, and the pus became more laudable. Since that 
 date, we have used cinchona in every case of similar nature, 
 with a prompt response. The condition of tissue is not that 
 of exuberant granulation, but indolent ulceration, with passive 
 hemorrhage. In one case, there was mastoid disease of long 
 standing ; a sinus opened upon carious bone. The action 
 of cinchona upon the middle ear, in non-suppurative inflam- 
 mation, is a subject upon which we are not prepared to speak 
 as we desire. That it causes hyperasmia of the tympanum 
 has been shown by Hammond and others. Roosa ' reports a 
 case of otitis, which illustrates the action of quinine on the 
 external ear as well as the labyrinth. We have a case under 
 treatment, where the otitis was aggravated, if not caused, by 
 quinine, the acute symptoms recurring every seventh day. 
 In two cured cases, — one in our own practice, the second 
 reported by a colleague, — the lesions were not of the external 
 or middle ear, but clearly of the internal. Of these cases 
 we will speak when considering the therapeutics of the 
 internal ear. 
 
 Elaps corallinus, — Indicated in the chronic suppurative 
 form of disease, complicated with naso-pharyngeal catarrh ; 
 the posterior wall of the pharynx covered with crusts, or 
 mucous membrane fissured ; nasal mucous membrane in same 
 condition ; external meatus full of offensive yellowish-green 
 discharge, which stains the linen green ; membrana tympani 
 
 ^ Roosa on the Ear, p. 169. New-York City, 1S85. 
 
146 LECTURES ON CLINICAL OTOLOGY. 
 
 usually perforated. Subjective symptoms : congestive lanci- 
 nating frontal and occipital head-ache, aggravated by motion 
 and stooping. This remedy is of great value in the naso- 
 pharyngeal catarrh, which complicates aural disease in chil- 
 dren. The patients are compelled to sleep with the mouth 
 open, on account of the obstruction of the nares ; hence the 
 term snuffles, used by mothers and nurses, 
 
 Ferruin pJiosphordcinn. — Schiissler claims that this salt 
 controls the beginning of disease. "Whilst iron restores 
 to their normal condition the blood-vessels, enlarged by dis- 
 ease, it heals the irritation-hyperaemia, which is the cause of 
 the first stage of all inflammations : . . . fresh, non-suppurat- 
 ing wounds are quickly healed by this remedy." This remedy 
 has been called, ''tissue aconite." One characteristic symp- 
 tom may guide to its use, — beating in the ear and head : the 
 pulse can be counted in the ear, one patient remarked. The 
 symptomotology of ferrum met. must be studied for confirma- 
 tions. 
 
 Gclscmhivi. — While this remedy may be more frequently 
 needed in acute disease of the middle ear, it may be specially 
 effective in mastoid disease, or acute necrosis, complicating 
 acute suppuration. (See Otitis Externa.) 
 
 Graphites. — The relation of this remedy to the nutrition 
 of the skin holds good in dry conditions of the mucous mem- 
 brane : indeed, we may infer very much of the condition of 
 the tympanum from study of the dermoid layer of the exter- 
 nal auditory canal. Hence the condition is that of sclerosis 
 or proliferous inflammation. The membrana tympani may be 
 opaque and thick, or transparent and very thin, adherent to 
 ossiciila or promontory, or perhaps mobile ; Eustachian tube 
 dilatable, but hearing, not improved by inflation. There is 
 one subjective symptom which is characteristic, — ''hearing 
 improved in a noise." Writers upon aural surgery differ 
 widely regarding this matter. Von Troltsch treats the mat- 
 ter very lightly, as if the patient's statements were faulty. 
 Kramer and Wilde accept the fact, but fail to account for it. 
 Dr. Peter Allen,' Aural Surgeon to St. Mary's Hospital, 
 
 ^ Lecaires n. Aural .Gatarrh, p. 29. London, 1S70. 
 
SL'MMAI^Y OF REMEDIES. 1 4/ 
 
 London, England, gives an explanation which is satisfactory, 
 one which we have been able to confirm. Space will not 
 suffice to go into the details of the physiological action of the 
 muscles of the tympanum : we will simply state, that any 
 change in the tympanum which either presses the stapes 
 into the fenestra ovalis, or draws it out beyond normal rela- 
 tions, changes the tension of the serous fluids of the internal 
 ear; and this causes subjective sounds. Such changes do 
 occur in the dry, atrophied condition we are considering, and 
 the atrophied muscles cannot sustain the ossicula in their 
 normal relations under ordinary sound-waves : when, how- 
 ever, the patient is subjected to extraordinary continuous 
 sound-waves, a reflex action stimulates the muscles, the sound 
 ceases, and hearing improves. This can be done by elec- 
 tricity, as we have shown in our article read before the 
 Homoeopathic Medical Society of the State of New York, 
 1875. That which is done by the heavy sound-waves, or bv 
 electricity, is accomplished by graphites in a gradual manner : 
 the function of the tympanic muscles is restored when the 
 nutrition is re-established. 
 
 Hcpar snip Jul j'is c ale area. — In the suppurative forms ; 
 membrana tympani perforated ; ulceration angry ; discharge 
 small amount, sour, fetid odor ; the tissues very sensitive, 
 often covered with white shreds, which cling to the ulcer. 
 Subjective symptoms : soreness in small spots about the ear; 
 itching ; patient worse at night and by cold air. 
 
 Hyeirastis eanaelensis stands first among remedies for muco- 
 purulent discharge from the middle ear. We should expect 
 this from its action on mucous membranes elsewhere. In 
 purulent inflammation of the middle ear, with thick, tenacious 
 discharge, more mucus than pus, this remedy is invaluable. 
 Compared with kali bichromicum, there is less tendency to 
 granulations about the perforation of the membrana tympani, 
 less crackins: and crustins: of mucous surfaces. 
 
 Iodine. — In chronic non-suppurative disease. Curative in 
 atrophy of mucous membrane, probably by stimulating gland- 
 ular elements of structure. (See graphites.) 
 
148 LECTURES ON CLINICAL OTOLOGY. 
 
 Kali bichromiaim. — In chronic suppuration ; the mem- 
 brana tympani perforated ; the cicatrization of the edges of 
 the perforation complete ; the tissues have an appearance as 
 if changed to mucous membrane, and the secretion is often 
 more mucus than pus ; the discharge yellow, thick, tenacious, 
 so that it may be drawn through the perforation in strings. 
 The subjective symptoms are, lancinations, sticking sensa- 
 tions, that the patients are not able to locate with any degree 
 of positiveness. 
 
 Kali Jiydriodiann. — The iodide of potash is a valuable 
 remedy in catarrhal, suppurative, or serous disease, if the diag- 
 nosis of specific disease is clearly made. In attenuation, it 
 is a parallel of acute and chronic naso-pharyngeal catarrh. 
 
 Kali vturiaticum (Schiissler). — One of the most effective 
 remedies we have ever used for chronic catarrhal inflamma- 
 tion of the middle ear, specially of the form designated "pro- 
 liferous." The subjective symptoms, as learned from clinical 
 use, are not numerous : a stuffy sensation in the recent cases, 
 subjective sounds, and deafness, are very marked. The ob- 
 jective symptoms are, the naso-pharyngeal obstruction, the 
 effort to clear the fauces, the granular pharyngitis, pharyn- 
 geal tonsil, closed Eustachian tube, retracted Mt., and atro- 
 phied walls of the external meatus. In chronic suppuration, 
 it reduces proliferation, checks granulation, hastens repair, 
 probably by action on mucous membrane (compare silicea), 
 and gives an increased power to withstand exposure. Its 
 action seems more decided on the right Et. (Compare 
 mere, deitt.) 
 
 Kali pJiosphoriejtm (Schiissler). — For suppurative disease, 
 specially chronic form, Schiissler writes thus : " Potassium 
 phosphate cures the following diseased conditions : septic, 
 scorbutic bleedings, mortification, encephaloid cancer, gan- 
 grenous croup, phagedenic chancre, putrid-smelling diarrhoea, 
 adynamic typhoid conditions, etc." From the foregoing indi- 
 cations, we were led to use it in ulceration of the membrana 
 tympani, with or without perforation, in suppuration of mid- 
 dle ear, the pus being watery, dirty, brownish, very fetid, the 
 
SUMMARY OF REMEDIES. 1 49 
 
 ulceration angry, bleeding easily, and showing little tendency 
 to granulate, or secrete laudable pus. It is specially valuable 
 in old people. 
 
 Kali sulpJuLviciLin (Schiissler). — For catarrhal disease or 
 suppuration, if the discharge be muco-purulent rather than 
 purulent. The guiding symptom is the color of the secre- 
 tion, which is yellow and sticky, tenacious. It has an action 
 on the Eustachian tube similar to the kali muriaticum. 
 
 LacJiesis. — This remedy has been curative in some cases 
 of the proliferous form, the objective symptoms being sim- 
 ilar to those given under graphites : the subjective symptoms 
 cf left-sided deafness, and aggravation after sleeping, led to 
 its selection in lesions after typhoid or typhus fever and 
 diphtheria. 
 
 Lycopodiimi. — For scrofulous subjects, those who suffer 
 from moist eruptions, abdominal troubles, sequela of scarlet- 
 fever, etc. Hence used in the suppurative form : the mem- 
 brana tympani is often destroyed, with the exception of a 
 small margin, the ulceration showing no disposition to heal, 
 but not sensitive to touch, as under hepar ; the pus is offen- 
 sive, not profuse, and inclined to crusts if not frequently 
 cleansed. 
 
 Magnesium phosphate (Schiissler). — The action claimed 
 for this remedy is upon the muscles, nerves, brain, bones, 
 and teeth. It is very effective in neuralgia. Dr. William 
 E. Rounds (my colleague in the Ophthalmic Hospital) sug- 
 gested its use in the proliferous form of middle-ear disease. 
 I believe it supplements the kali mur. 
 
 Merciiriiis biniodide. — For similar conditions to those for 
 which the metal has been given, but its action on the left 
 Eustachian tube is the special indication for administration. 
 
 MerciLviiis didcis. — In the "Homoeopathic Times," April, 
 1875, we gave the reason for employing this remedy in chronic 
 catarrhal inflammation of the middle ear. Time has con- 
 firmed the anticipations raised by its first trials. The ob- 
 jective symptoms are those of this form of inflammation, — 
 the membrana tympani retracted, thickened, and immovable 
 
150 LECTURES ON CLINICAL OTOLOGY. 
 
 by inflation ; a granular or hypertrophied condition of the 
 pharyngeal mucous membrane. The subjective ones are 
 those of a benumbed, dull feeling between the throat and 
 ear, a pressure in the ear from without ; with these, the 
 subjective symptoms of irritation of the auditory nerve from 
 pressure or tension on the stapes and fenestra rotunda, 
 humming, roaring, and singing : these fade as the audition 
 increases. In many cases, the more intelligent patients can 
 give the moment when the air passes, for the first time in 
 months or years, from the throat to the ear. Of this form 
 of disease, Toynbee writes thus : ''This affection is less 
 prevalent in the young than in adults, in whom it is liable to 
 occur after repeated attacks of cold, whether with pain or not. 
 It is, however, most frequent in persons advancing in life, 
 and may, in fact, be considered as the disease which causes 
 deafness in advancing years. The generally received opinion, 
 that in this kind of deafness the nervous system is at faulty 
 is manifestly incorrect, as proved by the symptoms, and by 
 the mode of relief found beneficial." It is to this condition 
 that mercurius dulcis is proven to be homoeopathic. 
 
 MerciiriiLS pivtoiodide. — The objective indications for the 
 iodides of mercury are, the thickness of the tissues of the 
 fauces, the lobulated tonsils, with deep intra-spaces. The 
 protoiodide acts specially on the right side. 
 
 Meixitrins vivns. — In chronic suppuration, with enlarged 
 and sensitive cervical glands, resulting from sudden colds. 
 The membrana tympani is not broken down to a very great 
 degree, and often repairs very promptly, even in cases where 
 the perforation has existed for months : the discharge is pus, 
 fetid, whitish, or mingled with blood. Subjective symptoms : 
 tearing pains with the discharge, these aggravated by any 
 cold which checks the free flow of pus ; also worse by lying 
 on the ear in bed. 
 
 Mezereiun is valuable in some cases of sensitiveness of the 
 mucous membrane of the middle ear. " The ears feel as if 
 too open, as if the tympanum were exposed to the cold air, 
 and it blew into the ear." This has been repeatedly con- 
 firmed. 
 
SUMMARY OF REMEDIES. 151 
 
 Nitric acid. — In ulceration, caries of the ossicula or mas- 
 toid process, the remote results of syphilis or abuse of mer- 
 cury. Subjective symptoms : shooting pains ; sensitiveness 
 of the bones ; aggravated by every change of temperature, 
 also at night, on waking, or rising from a seat, and by touch 
 (see Aurum) ; better while riding in a carriage. Fluoric acid 
 has inclination to uncover and to wash with cold water (see 
 silicea). 
 
 NiLx vomica. — In irritation of the mucous membrane of 
 the middle ear ; " itching in the Eustachian tube, provoking 
 swallowing." Similar to causticum symptom. 
 
 PJiospJionis corresponds to a dry condition of the tympa- 
 num. One objective symptom, deafness, is interesting in 
 this respect, that the failure is especially for the human voice : 
 noises and musical tones are recognized much more readily 
 than the modulations of voice. It is undoubtedly true that 
 we must look for an explanation of this fact in the functions 
 of the tympanum, and hope that a more complete knowledge 
 of its physiology will reveal the reason. 
 
 Phytolacca dccandra. — Occasionally indicated in acute 
 inflammation of the middle ear : the symptoms of the pharynx 
 and Eustachian tube guide in the selection. Shooting pains 
 in both ears when swallowing ; worse on right side ; Eusta- 
 chian tube obstructed ; fauces dark, bluish-red ; tonsils large, 
 bluish, ulcerated ; throat feels rough, hot, dry, with burning 
 smarting. Valuable in diphtheria and malignant form of 
 scarlet-fever. 
 
 ' Psorimnn. — A remedy closely allied to sulphur. Bell ' 
 writes, " Whether derived from purest gold or purest filth, 
 our gratitude for its excellent services forbids us to inquire 
 or care." In chronic suppuration, where the symptoms 
 remain unchanged after sulphur, the ulcers scab over rap- 
 idly ; the pus very fetid, with the ulceration of the membrana 
 tympani ; scabby ulcers on the vertex and behind the ears. 
 Subjective symptoms : excessive itching in the ears, so that 
 children can hardly be kept from picking or boring in the 
 meatus. 
 
 ^ Bell, on Diarrhoea and Dysentery. New-York City, 1869. 
 
152 LECTURES ON CLINICAL OTOLOGY. 
 
 Pulsatilla. — For acute catarrhal inflammation, or chronic 
 suppuration, when the discharge is a bland muco-purulent 
 secretion. Fever without thirst, relief of pains in the open 
 air, and a peevish, changeable, timid disposition, indicating 
 the nervous depression, are guiding symptoms, 
 
 Qidniiie. — The muriate of quinine is the remedy for the 
 conditions sometimes noticed in acute suppuration, when the 
 exudation of lymph and pus suddenly ceases, and the deeper 
 tissues become involved, thus threatening death by acute 
 necrosis or cerebral lesion. The case which led me to the 
 use of the drug was unique. A young physician, who had 
 had chronic catarrhal otitis for many years, was attacked with 
 acute otitis media : the membrana tympani was very thick 
 and unyielding ; upon incising it freely, the pain was relieved ; 
 a free discharge followed ; twenty-four hours later, the flow 
 ceased quite suddenly, and the case became critical. Sick- 
 ness prevented my attention to the patient at his house. 
 Dr. Rounds saw him, at my request : he called Dr. Liebold 
 for counsel, who advised the muriate of quinine ; it was given, 
 with prompt and permanent results. Since then, we have 
 used it in all similar cases, as well as in any with marked 
 periodicity either of pain or secretion. 
 
 Silicea. — In chronic suppuration; ulceration in cachectic 
 subjects, or those who have been dosed with mercury ; in 
 caries or necrosis. Objective symptoms : membrana tympani 
 perforated and irregular ; secretion of pus scanty ; ulcers 
 deep, and covered with scabs unless frequently cleansed. The 
 theoretical relation of silicea to the periosteum would lead us 
 to expect curative action when the middle layer of the mem- 
 brana tympani {substantia pi^oprid) is involved, and clinical 
 results do not disappoint us. It has been our view, that 
 more repairs of the membrane occur under the use of this 
 remedy, in chronic disease, than under any other single 
 remedy. 
 
 SiilpJmr. — The indications for this remedy must be sought 
 in general rather than in the special objective and subjective 
 ones, as they are meagre compared with the last-mentioned 
 
SUMMARY OF REMEDIES. I 53 
 
 remedy as well as others. Itching in the ears, drawing or 
 shooting pains in the ears ; discharge of pus, stinking, with 
 crusts. 
 
 Teiicrmm maritm verum. — This is the only remedy under 
 which we are able to say we have seen mucus accumulations 
 disappear from the tympanum. In one case, the Politzer's 
 method was used in connection with remedies : the accumu- 
 lation persisted till teucrium was used. '' One swallow does 
 not make a summer." We are cautious in attributing to 
 remedies that which belongs to mechanical means. The 
 symptoms, as given by Dr. Dudgeon, certainly suggest the 
 above condition : " Sometimes fine ringing in right ear, on 
 blowing the nose ; a peculiar chirping sound, as if air passed 
 itself through mucus ; thereafter the ear remained some time 
 stopped up, and opened up again with a dull sound." 
 
 Tellurium. — Curative in chronic suppuration, when the 
 symptoms correspond to the following : a watery fluid, smell- 
 ing like fish-pickle, which excoriates the meatus and the skin 
 wherever it flows. After the suppuration has ceased, the 
 membrane has been found cicatrized and corrugated, but not 
 thickened. 
 
 Thuya oc. — The special indication for this remedy is the 
 discharge ''smelling like putrid meat." Clinically, it has 
 cured granulations in the meatus similar to condylomata. 
 
Part Third. 
 
 DISEASES OF THE INTERNAL EAR. 
 
ELEVENTH LECTURE. 
 
 INFLAMMATION OF THE INTERNAL EAR. 
 
 Diseases of Interiial Ear. — The consideration of this sub- 
 ject will serve to illustrate what I said at the outset, of the 
 two ways in which knowledge of the diseases of the ear is 
 obtained. 
 
 The literature upon otitis interna is made, upon the one 
 hand, of clinical cases, in which the history of the patient 
 shows more or less evidence of disease which can be referred 
 to the tissues of the labyrinthine acoustic nerve in its 
 branches or origin, or both. Again, a second class of cases 
 are those in which post-mortem examinations have revealed 
 lesions of the sound-perceptive apparatus, independent of, or 
 secondary to, disease of the tympanum. Unfortunately, 
 however, these cases have not been identical, with a very few 
 exceptions : hence the pathological results cannot be ex- 
 plained by the clinical history ; nor, on the other hand, has 
 history of the life-experience been explained by the post- 
 moi'tem examination. Enough, however, is understood to 
 warrant our assertion, that there is a very close parallelism 
 between diseases of the eye and the ear, both as regards the 
 conducting and the perceiving portions of the apparatus. 
 Formerly, diseases of the nervous portion of the auditory 
 mechanism were as obscure as were the diseases of the fun- 
 dus of the eye previous to the invention of the ophthalmo- 
 scope ; and the term '* nervous deafness " had as wide and 
 as vague a meaning as the term "amaurosis" formerly had. 
 Careful clinical observation and pathological research have 
 
 157 
 
158 
 
 LECTURES ON CLINICAL OTOLOGY. 
 
 cleared this field of study of its uncertainties ; and, while 
 there is much to- be done, time will give us as clear and sat- 
 isfactory a classification of diseases of the internal ear as 
 we now have of the middle ear. There is no reason in the 
 
 External 
 
 f Acoustic 
 ^^ nerve. 
 
 A Diagram designed to illustrate the Physiology of the Labyrinth, 
 (^Professor A. L. Ranney.) 
 
 I. External auditory canal 2. The membrana tympani. 3. The tympanic cavity with its chain of 
 bones connecting 2 with 4 4. The fenestra ovalis. 5. The utricle, communicating with the 
 semicircular canals (11, 12, and 13). 6. The saccule, communicating with the scala vestibuli 
 of the cochlea (5". f'.). 7. The ampullae. 8. The fenestra rotunda, opening from the scala 
 tympani (S.T.) into the tympanum (3). 9. The Eustachian tube, allowing the entrance of air 
 from the pharynx into the tympanic cavity. 10. The internal auditory canal, transmitting the 
 acoustic nerve. 11, 12, 13. The semicircular canals. 14. The opening of the mastoid cells 
 into the tympanic cavity (3), and the external auditory canal (i). S.F. Scala vestibuli of the 
 cochlea. S.T. Scala tympani of the cochlea. C. Cupola. (From Roosa's Treatise.) 
 
 nature of things why we should not have hyperaemia, inflam- 
 matory action of the higher grades, serous exudations over 
 more or less of the auditory tract, hemorrhagic exudations, 
 or even suppurative processes. These may be primary, aris- 
 ing from no traceable causes, — hence as truly idiopathic as 
 similar diseases in other portions of the body. That they 
 
IXFLAMMATIOX OF THE IXTERXAL EAR. 1 59 
 
 are also secondary to inflammations of the cavity of the 
 tympanum, or to the cranial cavity, we have every reason to 
 believe, from evidences afforded by post-nwrtcni examina- 
 tions. Indeed, inflammation may result in exudation which 
 may be quite local, and involve only a portion of the terminal 
 mechanism of the auditory nerve in the labyrinth ; and the 
 results of this exudative disease may be permanent, or may 
 entirely disappear. The earliest observations on this subject, 
 tending to the recognition and classification of the diseases 
 of the labvrinth, were made by Tvleniere, in i860. This 
 gentleman called attention to certain cases characterized by 
 symptoms which had been considered cerebral in their origin, 
 such as sudden deafness, dizziness, nausea and vomiting, and 
 loss of equilibrium. These cases led to his endeavor to con- 
 firm the following propositions : — 
 
 1. ''An auditory apparatus, hitherto perfectly normal, may 
 become suddenly the seat of functional disturbances, consist- 
 ing in noises of a variable nature, continuous or intermittent, 
 and w^hich may be accompanied, sooner or later, by a diminu- 
 tion in hearing." 
 
 2. "These functional troubles, having their seat in the 
 internal auditory apparatus, may give rise to symptoms which 
 have been considered cerebral, such as intense vertigo, uncer- 
 tainty of gait, turnings to the right or left, and falling ; and 
 they may be attended with nausea, vomiting, and syncope." 
 
 3. "These accidents, which are of intermittent type, are 
 at last followed by deafness, gradually growing worse ; and 
 often the hearing is at last suddenly and totally lost." 
 
 4. '' All this tends to confirm the belief that the lesion, 
 which is the cause of these functional troubles, is in the 
 semicircular canals." 
 
 Burnett,' in commenting on these propositions, calls atten- 
 tion to the fact, that some of the symptoms on which ^Meniere 
 laid stress are not always present in disease of the internal 
 ear ; also that some of these symptoms may be caused by 
 irritation of the external ear, as well as lesion of the tym- 
 
 ^ Treatise on the Ear. Charles H. Burnett, M,D. Philadelphia; Penn.. 1S77. 
 
l60 LECTURES ON CLINICAL OTOLOGY. 
 
 panum : still, to the French author belongs the honor of 
 initiating a closer analysis of these conditions ; although ex- 
 ceptions have been taken to some of his conclusions. 
 
 Subsequent study by other observers has led to a still 
 closer differential diagnosis between diseases affecting the 
 labyrinth, and those affecting the lab)rrinth, brain, and spinal 
 cord, or both ; and it is now well established, that diseases 
 involving the labyrinth alone were mistaken for diseases of 
 the brain. Before speaking of actual inflammation, I wish 
 to state, as summarily as possible, the points of the condition 
 now recognized as auditory vertigo, or labyrinthine vertigo, 
 independent of organic disease. The mention of a case 
 which I saw in consultation with a medical gentleman of this 
 city will illustrate this matter. A gentleman, who had usually 
 enjoyed good health, had overtaxed himself in his daily occu- 
 pation, — that of a court-stenographer, — and hence he was 
 below standard as regarded his general health. He was sud- 
 denly alarmed by an attack while in the court-room, having 
 many symptoms suggesting some lesion of the brain. He 
 became dizzy, nauseated, unable to sustain the centre of 
 gravity, and would have fallen save for assistance. He be- 
 came partially deaf, and, withal, very confused mentally. At 
 no time was the pulse above the normal, nor was there any 
 evidence of constitutional disturbance, such as a rise in 
 temperature, etc. On being conveyed to his home, this at- 
 tack passed without paralysis of any function ; and the hear- 
 ing came slowly back to its usual standard. He was obliged 
 to keep a recumbent position ; as any effort to sit or stand 
 erect would cause a recurrence of the vertigo, confusion of 
 the head, and a sense which he described as if the sounds 
 produced were far away, gradually receding as the vertigo 
 became greater. Being a very intelligent observer, he was 
 able to describe exactly the plane of gyration, which, if my 
 recollection is correct, was in the direction of the posterior 
 rather than of the perpendicular or horizontal semicircular 
 canal. The treatment consisted of rest, the administration 
 of kali brom. ; and, after an absence from business more cr 
 
INFLAMMATION OF THE INTERNAL EAR. l6l 
 
 less prolonged, all these symptoms disappeared without loss 
 of hearing. This is a typical case of auditory or labyrinth- 
 ine vertigo, and is undoubtedly functional in character. 
 
 Analogous to this, but giving results much more .serious, 
 is a primary idiopathic form of disease, very closely resem- 
 bling cerebro-spinal meningitis, for which, in some cases, it 
 has undoubtedly been mistaken. To this disease of the in- 
 ternal ear, Voltolini has given the term '' otitis labyrinthica ; " 
 and Dr. Knapp the term, "otitis interna exudativa serosa." 
 Some years since, I was called in consultation by Professor 
 Doughty, to see a girl some ten or twelve years of age, who 
 had suddenly lost her hearing while suffering from what he 
 supposed, at the outset, to be an attack of cerebro-spinal 
 meningitis. The child had all the symptoms of this dread 
 disease, save the spinal tenderness to touch, and the convul- 
 sive action. On the third day she suddenly became deaf, so 
 that, within a few hours, audition was perfectly obliterated. 
 Gn examination, I found the condition as above stated, and 
 expressed the opinion that it was a primary idiopathic dis- 
 ease of the labyrinth ; the loss of function being due to serous 
 exudation, and offering a very grave prognosis as regarded 
 recovery of the function. 
 
 My friend, W. S. Searle, M.D., of Brooklyn, had given 
 me, some time previously, a verbal account of a similar case, 
 in which he believed silicea had been of great value in over- 
 coming the serous exudation. The child was put upon gel- 
 semiiun first, every hour or half-hour, and intercurrent doses 
 of silicea every third hour. 
 
 Under these remedies, the fever, head-ache, occipital pain, 
 and other constitutional symptoms, gradually disappeared. 
 The hearing improved slowly but steadily, until the patient 
 was able to hear as perfectly as ever. I think we are war- 
 ranted in claiming this as an acute primary otitis interna ex- 
 udativa ; and the result obtained was due, I believe, to the 
 immediate administration of remedies. 
 
 In two other similar cases, the loss of function was com- 
 plete and permanent, the patients receiving no treatment 
 
1 62 LECTURES ON CLINICAL OTOLOGY. 
 
 directed especially to the preservation of the acoustic func- 
 tion. In one of these cases, the patient had suffered from 
 suppurative disease of the middle ear on one side for many 
 years, and in a summer evening, while playing croquet, had 
 become very warm. Completing his part of the game, he 
 retired to the veranda of a house near by, where he sat in 
 his chair leaning against the house. He fell asleep, and was 
 suddenly awakened by a confusion of noises which he was 
 unable to distinguish. This was produced by the rest of the 
 party shouting at the successful termination of their game. 
 On attempting to rise, he found himself very dizzy, nause- 
 ated, and unable to control his steps sufficiently to walk to 
 his room. He retired, passed a somewhat restless night, and, 
 on waking in the morning, was alarmed at the excitement of 
 his wife, who was attempting to convey to him her own alarm 
 upon finding that he could not hear a single word which she 
 had spoken to him. The history of the case would lead to 
 the supposition that the hearing, up to that time, had been 
 normal ; as the patient had depended upon that ear for all 
 ordinary conversation. Examination showed no evidence of 
 middle-ear disease ; and the hearing for watch, as well as 
 the human voice, was absolutely nil. 
 
 In another instance (May i6, 1878), a lady, about thirty 
 years of age, was taken suddenly with severe pain in the 
 head, in the occipital region, nausea, giddiness, tinnitus au- 
 rium, and deafness of the right ear. She consulted her 
 family physician, who did not recognize the gravity of the 
 case, but thought her symptoms secondary to some gastric 
 or hepatic derangement. After various means had been 
 used, the nausea and giddiness gradually passed away ; but 
 the hearing did not improve. Six months later, on examina- 
 tion, I found the membrana tympani normal, the pharynx 
 only slightly catarrhal, whereas the hearing on the right side 
 was minus for the watch as well as for the tuning-fork. 
 
 On the left side the hearing was normal. The only cause 
 which could be found was that of a general debilitated con- 
 dition : otherwise, she was, and had been, in perfect health. 
 
INFLAMMATIOiV OF THE INTERNAL EAR. 1 63 
 
 Not satisfied with my diagnosis and prognosis, she consulted 
 eminent aurists in this city, who confirmed the diagnosis. 
 This, like the other case, was undoubtedly a serous exudation 
 in the labyrinth. It may seem assuming too much to claim, 
 that, from the history, these were cases of serous disease ; 
 but I see no reason why, under the same method of treat- 
 ment as already suggested, these cases might not have had 
 at least a degree of functional activity preserved. 
 
 In cases of otitis interna suppurativa or hemorrhagica, 
 the loss of hearing is sudden and permanent. That there 
 may be a localized suppurative inflammation, as well as local- 
 ized serous inflammation, it seems to me the reports of 
 pathological examinations fully warrant. Otherwise, we can- 
 not explain cases in which there is loss of portions of the 
 musical scale. Theoretically, we infer, that, if a proportion 
 of the lower tones is lost, the long turns of the cochlea are 
 the portion involved : conversely, if the high tones are lost, 
 the turns near the apex of the cochlea are involved. You 
 can understand, that any exudations occurring in the laby- 
 rinth, in the tract of the acoustic nerve, or within the cranial 
 cavity, which are absorbed without pseudo-organization, 
 would, for the time being, cause a failure of the function, 
 which might be gradually restored as the exudation was ab- 
 sorbed. If the exudation became purulent or hemorrhagic, 
 you can understand that the disorganization resulting there- 
 from would be so serious that any restoration of the function 
 of the part involved would be simply impossible. Such is 
 the history of cases which we are led to suppose are either 
 hemorrhagic or purulent. The same is true of inflammation 
 of the internal ear, secondary to syphilis. This matter has 
 been quite fully considered by various authors ; and we find 
 them divided into those who think that the preponderance of 
 the lesion is found in the pharynx, and that otitis interna 
 syphilitica is a very rare form of disease : hence, that which is 
 considered as primary by some, is really secondary to disease 
 of the middle ear and pharynx. 
 
 In February, 1878, I was called upon to advise a young man 
 
164 LECTURES ON CLINICAL OTOLOGY. 
 
 who had suffered from catarrhal disease more or less foi* 
 years, but never previously from any disturbance in the mid- 
 dle ear ; nor was there, on examination, any evidence that the 
 middle ear was involved more than in thousands of cases, — 
 certainly not sufficiently to account for the sudden invasion, 
 increasing to serious and permanent failure of the function. 
 He had contracted syphilis two months previously, which 
 had shown secondary symptoms of the skin and hair-bulbs, 
 but no effects upon the mucous membrane until two weeks 
 later than the ear-symptoms. Suddenly he was aware of 
 slight dulness of hearing; subjective noises set in, the hear- 
 ing became duller and duller ; and, in his alarm, he was 
 advised to consult me. As stated, I found no sufficient 
 cause in the condition of the pharynx, Eustachian tube, mid- 
 dle ear : but examination with the tuning-fork showed per- 
 ception by aerial conduction to be better than that through 
 the cranial bones ; and the test by closing alternately the 
 right and left meatus, using the tuning-fork on the vertex, 
 zygoma, or glabella, failed of the contrasts which we know 
 to exist in cases in which the fault is one of conduction 
 rather than of perception. Iodide of potassmm and inerctc- 
 rius were of value in arresting the progress of the disease, 
 but there was no improvement over the standard recorded at 
 the first test. 
 
 In a number of instances, I have treated cases in which 
 there was undoubtedly a complication of middle-ear disease 
 and internal-ear disease ; and I am ready to agree with those 
 who would class such doubtful cases as secondary to middle- 
 ear disease rather than as an exudation, and, later, as puru- 
 lent processes secondary to the constitutional effects of the 
 virus, independent of the middle-ear disease. 
 
 Otitis interna may be either primary or secondary, at the 
 same time traumatic ; resulting, if primary, directly from the 
 shock or solution of the continuity of the labyrinth, independ- 
 ent of any middle-ear disease, or fracture of the temporal 
 bone, or shock of the acoustic nerve itself. It may be second- 
 ary to disease of the middle ear set up by the same force which 
 
IiiFLAMMATION OF THE INTERNAL EAR. 1 65 
 
 produced the shock, or secondary to traumatic causes which 
 affect the auricle, temporal region, meatus, and tympanum 
 directly, as from a blow immediately upon the parts. Frac- 
 tures of the temporal bone, allowing the escape of the laby- 
 rinthine fluids, must necessarily result disastrously. 
 
 Traumatic causes generally affect the middle ear, giving rise 
 to suppurative inflammation of the tympanum ; frequently, by 
 simple continuity of tissue, involve the internal ear, and de- 
 stroy the function of the labyrinth. These all, on the grounds 
 on which I have thus far considered the results, may be 
 hypothetically accounted for by reason of the pathological 
 processes ; and there is a large group of cases in which the 
 conditions have been classed as hyperaesthesia or torpor of 
 the auditory function, which cannot be as satisfactorily ex- 
 plained. 
 
 To illustrate : in October, 1881, a clergyman consulted m.e 
 for a distressing condition, which had existed for six years, 
 and which he believed to be due to an attack of vertigo, so 
 designated by himself, which occurred while he was specially 
 overtaxed by mental strain. The attack was described as 
 one of vertigo, with subjective noises, and a condition which 
 he described " as if a cloud had settled down upon the func- 
 tion of the acoustic nerve, as a cloud might settle down 
 upon the vision." Associated with this was a peculiar dis- 
 comfort upon hearing the low, musical tones produced by 
 any instrument, especially by the church-organ. 
 
 This particular symptom disappeared under the use of 
 chenopodiiim antkelminticiiin, and he was very much improved 
 by a mild current of galvanism. In this case, there was no 
 absolute failure of the function, such as can be tested and 
 recorded according to any of the usual standards ; but there 
 was a torpor and an unsatisfactory performance of the func- 
 tion, either of the terminal mechanism, or of the conduction 
 of the acoustic nerve, or the central perceptive relation be- 
 tween sound and idea. 
 
 Like in kind with this, are those cases of hyperaesthesia 
 in which the person is excessively sensitive to simple noises, 
 
1 66 LECTURES ON CLINICAL OTOLOGY. 
 
 regular vibrations in the air, or to some particular irregular 
 vibrations, or to some regular tones, either high or low, or 
 both, produced by musical instruments. In some cases, this 
 is marked by a peculiarity which recognizes the color or 
 quality, klaiig farbe (sound-color). These are analogous to 
 those symptoms of the optic nerve in diseased conditions 
 when the patient has illusions of color. That these are 
 necessarily due to organic changes, I do not believe ; that 
 they do exist with organic changes, is undoubtedly true, as 
 often the lesion is so great that the function is never re- 
 stored. The trunk of the auditory nerve also is subject to 
 changes in its structure, in the direction of atrophy, fatty de- 
 generation, metamorphoses analogous to those occurring in 
 the trunk of the optic nerve ; also to malignant changes, 
 which partially or wholly interfere with the function ; and 
 the same may be true of growths in the sheaths of the 
 nerve, or in the periosteum lining the internal auditory 
 canal. 
 
 You can readily understand how such processes would 
 cause failure, either partial or complete, without interfering 
 with the peripheral mechanism, being as absolute as when 
 the cochlea and semicircular canals are the subjects of serous 
 or purulent disease. 
 
TWELFTH LECTURE. 
 
 DEAF-MUTISM : HELPS TO HEARING. 
 
 Gentlemen, — When the hearing has fallen below the 
 normal standard, and internal remedies or instrumental 
 treatment fail to increase it, we are compelled to resort to 
 artificial methods for concentrating and conducting sound- 
 waves. In speaking of the treatment of perforations, I men- 
 tioned the artificial membrana tympani and the cotton pellet, 
 which are used as a substitute for the artificial membrane. 
 These serve not only as a means of treatment, in many cases, 
 promoting closure of the perforation, but, in cases where the 
 perforation remains permanent, the artificial membrane, or 
 the cotton pellet, acts to increase the hearing-power, by ad- 
 justing the relation of the ossicula, and thus conducts vibra- 
 tions which otherwise would not be communicated to the 
 nerve. 
 
 When the membrane has sloughed to a great extent, the 
 relation of the malleus to the incus is so changed, that they 
 are not in apposition, as in normal condition. This may be 
 illustrated by imagining the cogs of wheels, in gearing, to be 
 drawn apart, so that, instead of bearing fully in all their 
 parts, the cogs touch, as it were, only on their ends. The 
 action of the cotton pellet, or artificial drum-head, is similar 
 to that of replacing the cogs in their proper position, so that 
 the action of the gearing is easy and strong. 
 
 When the treatment of suppurative cases has progressed 
 so far that the purulent seeretion has ceased, the pledget of 
 absorbent cotton may be rolled into a small ball, and placed 
 
 167 
 
1 68 LECTURES ON CLINICAL OTOLOGY. 
 
 SO as to bear against the remaining portion of the manu- 
 brium of the malleus and the floor or walls of the canal. If 
 properly adjusted, the hearing-distance will be markedly in- 
 creased, unless adhesions have formed in such a way as to 
 prevent the vibration of the ossicula. The same is true of 
 the use of the artificial membrana tympani, but I have found 
 that the cotton pellet is much better tolerated. 
 
 The degree of hearing which is secured by this little de- 
 vice is remarkable, — in some cases in the proportion of one 
 to three, or higher, as one to ten. 
 
 In cases of chronic catarrhal inflammation, with thickening 
 of the membrana tympani, adhesions of the same to the os- 
 sicula or labyrinthine wall, or possible pseudo-anchylosis of 
 the stapes, some means must be used to concentrate and 
 conduct the sound-waves : these consist of various forms of 
 ear-trumpets. The conversation-tube consists of a flexible 
 
 Conversation-Tube. 
 
 tube, finished at one end with a tip fitted to the external 
 auditory canal, and at the other end with a bell-shaped 
 mouth-piece of hard rubber. This instrument is very accept- 
 able to some subjects, as it is not so cumbersome or notice- 
 able as the large trumpet. The trumpets have been made 
 in various forms. The best is the one constructed on the 
 same principle as that underlying the construction of speak- 
 ing-tubes, so that the air is thrown by vibration in right, 
 lines. All attempts at securing any increase of vibration by 
 small telescopic devices, must necessarily prove failures. In 
 cases of extreme deafness, the large so-called " dipper "- 
 trumpet is the only serviceable instrument. This has been 
 adapted by some instrument-makers so that it can stand on 
 
DEAF-MUTISM : HELPS TO HEARING. 1 69 
 
 a base, with the mouth towards the speaker, the vibration 
 being conveyed to the ear by a flexible tube. The best in- 
 strument of which I have any knowledge, constructed on 
 these principles, is North's earphone, so called, which con- 
 sists of a trumpet-shaped instrument, covered by meshes of 
 fine wire, which the inventor claims to be of great value in 
 modifying the vibrations. Whatever may be the theory upon 
 which it is constructed, it is an admirable instrument. 
 
 The fact that a person can hear the orchestral music in 
 the concert-room very much better by placing a cane upon 
 the floor, and resting the head of it against the teeth, or by 
 placing the brim of a Derby hat against the teeth, w4th the 
 crown turned towards the stage, suggested, in a crude way, 
 the principle which underlies 
 the audiphone and the denti- 
 phone. These instruments 
 are alike in principle and con- 
 struction, and consist of a 
 sheet of vulcanite, fitted with a 
 
 handle much like an ordinary "*^ Ear-Trumpet. 
 fan. Placed against the edge 
 
 of the teeth, with upward pressure on the handle, the instru- 
 ment is bent in the form of an arc, with its base inward. 
 It is fitted with silk cords passing from the upper edges to 
 the handle, so that the tension may be regulated and pre- 
 served while in use. The statements of patients are not 
 uniform as regards the use of these instruments, but people 
 evidently require some training in order to become proficient 
 in their use ; and, as they are less unsightly than the ordinary 
 trumpet, it will be well for a person requiring some aid to 
 make a trial of their use. Dr. Knapp has recorded, in '' The 
 Archives of Otology," the comparative merits of the dipper- 
 trumpet and the audiphone on very different patients, and 
 does not say much in commendation of the audiphone. 
 
 The instruction of the deaf-mute is a matter upon which 
 the advice of the general practitioner may be of such inesti- 
 mable value to the sufferer, that I desire at this time to urge 
 
I/O LECTURES ON CLINICAL OTOLOGY. 
 
 upon your attention the importance of methods of instruc- 
 tion, or, rather, what may be called improved methods of 
 instruction, compared with those in vogue in past years. The 
 child who is congenitally a deaf-mute, of course has no idea 
 of language as expressed by the speaking-child ; and the de- 
 velopment of mental powers must necessarily depend very 
 largely upon some substitute for this avenue of communica- 
 tion to the mind. In this matter, very great advances have 
 been made. The old method of dactylology, or finger-signs, 
 which has been taught for a long period, is being put in trial 
 with another system, which has been in use in Europe for 
 many years, more lately in this country. By this system, 
 the finger-alphabet is prohibited, as well as all sign-language ; 
 and the children are taught, not only to understand others by 
 watching the lips, but to use articulate speech themselves. 
 This is acquired by patient, diligent training of the powers 
 of imitation and observation. Every medical man is under 
 obligations to inform himself, as far as possible, of the merits 
 of these two systems, so that he may be able to give proper 
 advice when his opinion is asked upon this subject. 
 
 Dr. W. B. Dalby gives a very full description of the so- 
 called German method, in his lecture on "The Diseases of 
 the Ear," as also in an article entitled, "The Education 
 of the Deaf and Dumb by Means of Lip-Reading and Ar- 
 ticulation." The so-called German method of the instruction 
 of mutes may be briefly stated to consist in conveying to 
 the child's mind the idea of the sounds which are associated 
 with general positions of the lips and organs of speech. 
 
 Without going too fully into this subject, it is, perhaps, 
 sufficient, in this connection, to say, that this training begins 
 at seven years of age, the time when acquired deafness would 
 result in deaf-mutism as truly as in the case of the congeni- 
 tal ; and about eight years are occupied in the training, before 
 the child can practise lip-reading, so called. By numerous 
 objects necessary to attract the attention of the pupil, and 
 by various signs, which the apt teacher can employ as best 
 suited to his or her purpose, the child's intuition or percep- 
 
DISEASES OF INTERNAL EAR. — CASES. I7I 
 
 tion of the relation of things is stimulated. When once the 
 principle dawns upon the mind of the apt pupil, the mental 
 enlightenment of one who has been hitherto a prisoner, 
 finds, perhaps, its best description in Dickens's account of 
 Dr. Howe's training of Laura Bridgman. The same patience 
 and genius that led her soul out of bondage, will reap much 
 larger harvests in the practical application of lip-reading to 
 the necessities and enjoyment of every-day life. 
 
 Diseases of the Internal Ear. — Cases. 
 
 Ella W., aged 18, Elizabeth, N.J. Otitis interna tranma- 
 tica. Admitted April 12, 1883. About two or three weeks 
 since, fell fourteen steps, and struck upon a stone floor, thus 
 injuring right side of head, and impairing sight and hearing ; 
 sent by Dr. Sprague to see Dr. Norton, about April 7 ; has 
 had repeated hemorrhages from the right meatus and nose, 
 five or six per day ; examined also by Dr. Houghton ; no bone 
 conduction, faint aerial conduction. 
 
 April 12. Hearing gone, and numbness of right side, 
 head and arm ; two hemorrhages to-day, one from ear, one 
 from nose. 
 
 April 13. One hemorrhage ; progressive paralysis of motor 
 nerves ; retention of urine, drawn freely by catheter ; abnor- 
 mal position of the meatus urinarius. 
 
 April 14. Apparent complete paralysis of right arm ; 
 tongue thrust to right side ; could not swallow ; urine re- 
 tained ; one slight hemorrhage from nose in the afternoon ; 
 very bad night last night ; delirious ; temp., 99°, both sides, 
 axillae ; seemed better in the forenoon, worse in the after- 
 noon ; no appetite ; great thirst. Ferrimi phos. 
 
 April 15, I P.M. Urine still retained ; temp., 98°, left side ; 
 99°, right side ; excruciating pain in left side of head, coming 
 in paroxysms, five or six in twenty-four hours, lasting from 
 ten minutes to three-quarters of an hour ; very bad night — 
 little more rest after midnight ; no appetite ; thirst ; has 
 moved right arm to head ; swallowed better ; moved head to 
 left side; previously unable to do so, on account of great 
 
1/2 LECTURES ON CLINICAL OTOLOGY. 
 
 pain and tenderness of left side of neck ; falls into a drowse, 
 with snoring, about one minute, and awakens with a start ; 
 projects tongue only half an inch, and it seems difficult to 
 open mouth beyond half an inch. Ferrimi. 
 
 April 1 6. Temp., right side, 99° ; left side, 98.4° ; one 
 hemorrhage from nose at i p.m., not profuse ; intellect be- 
 wildered, memory lost, etc. ; fair night ; worse this forenoon 
 than at any other time ; paroxysms of pain, convulsive start- 
 ings still continue. Bell. 
 
 April 17. Several bad "spells" of pain ; urination volun- 
 tary; menses come on ; right arm moved while unconscious, 
 thrown up over head, and back with slow, heavy motion ; 
 temp., right side, 99°; left side, 97.6°; no hemorrhages. 
 Hyos. 
 
 April 18. Had hemorrhage from ear at 3 a.m., and from 
 nose at 9 a.m. ; crusted blood in L. meatus ; the slightest 
 touch causes pain on vertex ; says she can tell when she is 
 about to bleed, from sensation of fluid moving in head, gurgle 
 or rattle ; since hemorrhage, better of reflex symptoms of 
 stomach and convulsive movements ; temp., right side, 98° ; 
 left side, 97°. 
 
 April 19. Temp., right side, 97.3°; left side, 97°. 10 p.m. 
 Temp., right side, 99° ; left side, 98°. 10 a.m. Temp., right 
 side, 99.3°; left side, 99°. 
 
 April 20. Doing well ; dark hemorrhage from the ear last 
 evening at 9 o'clock ; rested well ; no change in the paralysis 
 motor or sensory. 11 p.m. Temp., right side, 99° ; left side, 
 98°. II a.m. Temp., right side, 99.4°; left side, 99°. 
 
 April 21, II P.M. Temp., right side, 99° ; left side, 98°. 
 
 April 22, A.M. Temp., right side, 99.4°; left side, 99°. 
 10 P.M. Right side, 99° ; left side, 98°. 
 
 April 23, II A.M. Temp., right side, 99.4°; left side, 99°. 
 10 P.M. Right side, 100° ; left side, 99.4°. 
 
 April 24, II A.M. Temp., right side, 99°; left side, 98°; 
 much better ; no hemorrhage ; moves left arm and fingers ; 
 sensibility returning in arm, but not in face and neck ; passes 
 urine to-day all right. 11 p.m. Temp., right side, 98.4°; 
 left side, 98°. 
 
DISEASES OF INTERNAL EAR. — CASES. 1/3 
 
 April 25, 10 A.M. Temp., right side, 98.3°; left side, 98°. 
 II P.M. Right side, 99° ; left side, 98°. 
 
 April 26, II A.M. Temp., right side, 98.4°; left side, 98°. 
 10 P.T>r. Temp., right side, 99° ; left side, 98.4°. 
 
 April 27, 10 A.M. Temp., right side, 98.4° ; left side, 98^". 
 10 P.M. Temp., right side, 98.4°; left side, 98°. 11 am. 
 Temp., right side, 99° ; left side, 98.4° ; sensation returned at 
 2 A.M., preceded by pain. 
 
 April 28. Much better ; no special symptoms. 
 
 May 7. Had gained till 6th ; head-ache, frontal, and run- 
 ning through side of head (R.) ; went out to walk at 10 a.m., 
 then quiet till evening ; went to church at 7.30 ; soon became 
 dizzy ; the lights seemed to go out ; kept quiet until the close 
 of services ; on way to cross the street, was nauseated till 
 near 10 p.m., when blood flowed from R. ear and R. nostril ; 
 then nausea ceased, and a beating sound, as of metal being 
 struck, was heard ; beats synchronous with pulse , R. Me., 
 crusted blood ; R. Mt., clear above, blood-scales below. Fer- 
 nun. 
 
 May 14. Was well last week, save nose-bleed, a slight 
 amount daily; has hemorrhage from ear to-day at 10 a.m. ; 
 feels chilly, and seems nervous ; pulse normal ; seems well in 
 other respects. 
 
 May 16. Hemorrhage last night, again since 12 m. ; 
 meatus tender to the pressure of speculum ; blood coagula 
 in the lower inner third of meatus. Hepar, 
 
 May 18. F'our hemorrhages since last visit, three from 
 ear, one from nose, dark and thick ; nervous ; sighing respira- 
 tion ; restless nights. Ign., fei'i^imi phos. 
 
 May 21. Had five "bleeding-spells" on the 19th, one last 
 evening about 8 o'clock, and one this forenoon ; "sees stars" 
 with right eye, on closing left ; less nervous ; sleeps better ; 
 less restless. 9 p.m. Had a bad nervous attack this morning, 
 teeth clinched, extremities cool, pulse slow and small ; had 
 been having several hemorrhages, through the day, of dark, 
 thin blood. Ergot and ignat. 
 
 May 22. Better this morning ; no hemorrhage ; head-ache 
 
1/4 LECTURES ON CLINICAL OTOLOGY. 
 
 on right side of face, and across forehead ; right side of face 
 flushed. Bell. Hemorrhage from nostrils and meatus at 
 2.30. Ipec. 
 
 May 23. Had hemorrhage this morning ; has a dark clot 
 in meatus, and walls look as if abraded ; Mt. more tender. 
 Ham., hyos. 
 
 May 25. Bled five times yesterday, quite profusely, from 
 ear and nose ; blood still dark. Ham., hyos. 
 
 May 31. Has the hemorrhage when she goes by herself 
 into the water-closet ; has had only one at any other time. 
 Ferrum, hyos. 
 
 June I. No hemorrhage since the 28th. Fcrnim, hyos. 
 Menses appeared on the 28th, one day, dark and very scanty. 
 Ferriim, hyos."- 
 
 Case No. 21. — Alice Chamberlain, aged twenty-one years. 
 Otitis interna. Dec. 20, 1882. Three years ago her vision 
 began to fail. Two years later, the hearing became impaired. 
 She has been subject to frequent and prolonged attacks of 
 head-ache. The failure of hearing was first noticed as asso- 
 
 * June 25. The patient was discharged at the above date, and went to her former 
 employer. To-day she called at my office. As the menses are about to appear, the head 
 is more confused, and blood flows from the meatus, but not from the nose ; the floor of 
 the canal is red, sensitive, and covered with light-colored bloody fluid ; no point of rupture 
 in canal or Mt. can be seen ; the general condition is better than one month ago. 
 
 This case is interesting, because of so good a degree of restoration. Prognosis was 
 guarded, and the diagnosis was not clear till the removal of tenderness of cervical muscles 
 of left side was followed by restored motor and sensory function of the right side. 
 Brown-Sequard mentions some cases of central lesion with paralysis of same side. Dr. 
 St. Clair Smith called my attention to cases in Archives of Scientific and Practical 
 Medicines, February, 1878. It seems clear that the blow upon the temporal bone, which 
 caused the lesion of the internal ear, also caused temporary failure of the function of both 
 anterior and posterior cords of cervical nerves ; this giving a condition which caused much 
 solicitude and debate. As regards the future history of the case, I anticipate a gradual 
 repair of the lesion of the temporal, and cessation of the hemorrhage. 
 
 May 25, 1885. Ella W. returned to the New-York Ophthalmic Hospital a few days 
 ago, and the following additional facts were learned : Soon after returning to service, the 
 hemorrhages returned. She was admitted to some hospital in Elizabeth, at the request 
 of the priest. There she had numerous hemorrhages ; anaesthesia of right side ; the 
 skin became dark, and remained so for weeks. In October she was able to sail for Ire- 
 land. During the voyage she was very sick, and for two weeks after landing : from that 
 time she made rapid progress. In November the flow of blood ceased entirely, and she 
 seems in perfect health. There is complete absence of aerial and bone conduction. 
 
DISEASES OF INTERNAL EAR. — CASES. 
 
 /:> 
 
 ciated with a constant noise, as the rolling of barrels, the 
 sounds of moving wagons, near her. The same morbid pro- 
 cess, which progressed two years in the optic tract, had now 
 undoubtedly commenced its ravages in the auditory trunk. 
 The persistent head-aches to which she was subject must be 
 considered a grave symptom when associated with either the 
 optic or auditory nerve disease. It is only by analyzing any 
 given case, including its history, that you will be able to 
 determine whether the head-ache is due to centric causes, or 
 symptomatic of some disease of the organism, possibly of 
 some remote part. This case was clearly an idiopathic dis- 
 ease. The remedy which arrested the neuritis was spigclia, 
 prescribed by Professor George S. Norton, M.D., from whose 
 clinic she came to me. The tinnitus aurium has increased 
 during the past year, and is associated with a sensation of 
 vertigo, especially on raising the head after waking in the 
 morning, the bed seeming to revolve in a horizontal plane. 
 
 March, 1883. This patient has improved steadily under 
 the use of spigelia : the optic neuritis has been arrested, the 
 vertigo has passed, the tinnitus aurium has been reduced to 
 a minimum, and every thing indicates the arrest of the mor- 
 bid process which threatened to abolish both functions. 
 
 Case No. 18. — Bella Bronson, two and a half years of age. 
 Otitis interna secondaria. Dec. 20, 1882. When this child 
 was ten weeks old, she was taken with fever of some type, 
 and, so far as the history of the case can be determined, 
 recovered without apparent trace of brain-trouble. She came 
 to the clinic yesterday, possessing the same degree of nat- 
 ural brightness and joyous activity which you see her present 
 to-day ; but I am sorry to say that she is afflicted with disease 
 of the internal ear. In this case, as you will actually find, 
 the diagnosis is reached by exclusion. Examination reveals 
 that the external and middle ear are normal : therefore the 
 defective hearing must be due to disease of the internal ear. 
 She has enjoyed perfect health. The tests that have been 
 applied show that she gets some idea of sound ; but whether 
 by vibrations communicated to her by aerial waves, or whether 
 
1/6 LECTURES O.V CLINICAL OTOLOGY. 
 
 by the shock conveyed to the body through contact with the 
 floor, it is impossible to determine in so young a child : I 
 believe, though, that the child is a deaf-mute, as the result 
 of fever when she was ten weeks of age. 
 
 I now recall the case of the girl, ten years of age, who 
 was taken with what was believed to be cerebro-spinal men- 
 ingitis. On the fourth day of her illness she was attacked 
 with sudden loss of hearing. The case was under the care 
 of Dr. Doughty, who called me in consultation. After ex- 
 amination, I determined that the disease was not one of the 
 middle ear, nor were there evidences of spinal or cerebral 
 lesion, as in cerebro-spinal meningitis. She was placed un- 
 der the influence of gclsenimm, with intercurrent doses of 
 silicea. The gelsemium was given on the marked indica- 
 tions of the pulse, and the head-symptoms as given by the 
 child ; and the silicea on the presumption that the pathological 
 conditions were as noted by Dr. Searle of Brooklyn, he hav- 
 ing relieved a similar case of otitis interna serosa with that 
 remedy. Immediate improvement was manifested : in twenty- 
 four hours she had improved ; in ten days the hearing-power 
 had been restored to a very great degree ; in six weeks, there 
 was a normal condition of the patient, and perfect hearing. 
 I refer to this case again, in order to impress upon you the 
 importance of detecting the primary symptoms, so as to 
 guide the differential diagnosis between otitis interna and 
 cerebro-spinal meningitis, which shall avert the progress of 
 the disease. The same testimony of the importance of the 
 early recognition of this condition will be found in the record 
 of cases reported in this country and in Europe. 
 
 Professor H. Knapp, M.D., remarks, that, ''when the serous 
 exudation passes beyond the acute stage into that of pseudo- 
 organization, the case is hopeless." 
 
 I am satisfied, that, in this case, the serous exudation was 
 controlled, and destruction of the termmal nerve-filaments 
 was averted, by the prompt administration of the remedies. 
 
SCMMARY OF REMEDIES. 1 7/ 
 
 Summary of Remedies. 
 
 CJicnopodiiini antJicluiiiiticuvi. — '''Deafness to the sound of 
 the voice, but exquisite sensitiveness to the sounds of passing 
 vehicles ; he remarked, as each vehicle rolled by, that it 
 sounded like the roaring of immense cannons right into his 
 ear ; also annoying buzzing in ears. During all this time, 
 his deafness, as described, was progressive, and became so 
 pronounced as to make it impossible to talk to him. Still, 
 there was the same kind of sensitiveness to other sounds. 
 For example, Avhen the tea-bell rang, though he was in the 
 third story, three flights from where the sound came, he, 
 without notice from members of his famih', to their utter 
 astonishment, got up and walked, as deliberately as ever, into 
 the dining-room." 
 
 CincJiona, and especially its alkaline proximate principle, 
 quinia, has been long recognized as having toxic effect on 
 the ear. The symptoms produced by the proving, point to 
 impressions upon the labyrinth, such as produced by sudden 
 abstraction of blood ; viz., vertigo, from loss of blood ; gid- 
 diness, from anasmia ; faintins^ ; rincrins: in ears. In some 
 subjects, a fine ringing in the ears is caused, associated with 
 a general nervous erethism. As a remedy, cincJioua proves 
 curative in these two opposite conditions, and acts upon both 
 cochlea and semicircular canals. 
 
 Roosa ' gives decided testimony as to the effect of quinine. 
 *' I believe that the tinnitus aurium, and impairment of hear- 
 ing, following the use of quinine, depend upon congestion of 
 the ultimate fibres of the auditory nerve in the cochlea ; and 
 that the redness of the drum-heads is mereh" an index of 
 the former condition.'' He quotes Kirchner to this effect : 
 " Quinine causes inflannjiatory processes and permanent patJio- 
 logieal changes in the ear. He believes that the cause for these 
 conditions is to be found, not only in a hyperceniia of short 
 duration, but also in paralysis of the vessels, zuith conges- 
 tion and exudation.'" Also, Dr. J. Orne Green, as follows : 
 
 ^ Treatise on Diseases of the Ear. p. 619. New York. 1SS5, 
 
1/8 LECTURES ON CLINICAL OTOLOGY. 
 
 ^^ From our present knozvledge^ both clinical and experimental, 
 we are jnstificd in asserting, that tJie action of qninine npon 
 tJie ears is to produce congestion of the labyrinth and tympanum, 
 and sometimes distinct inflammation, with permanent tissne- 
 cJianges'' 
 
 Thus the modern scholars give reasons on a pathological 
 basis, for the truth of observations made by Samuel Hahne- 
 mann just one century ago. We shall still need to follow 
 his lead, to solve the action of cinchona. 
 
 Ferritm phosphoricnm. — For the same general symptoms 
 as in middle-ear disease ; i.e., the first stages of inflamma- 
 tion. (See Otitis Media.) 
 
 Gelseminm. — In otitis interna serosa. (See symptoms 
 under Otitis Media.) 
 
 Hydi'obromic acid. — There is no proving of this remedy: 
 hence our use of it has been guided by the cases reported 
 by Drs. Woakes, Turnbull, and others. Like the bromides, 
 it is a strong sedative, in doses of from five to thirty drops. 
 A convenient method is to put thirty drops in three table- 
 spoonfuls of cool water ; add sugar to suit the taste, and 
 take a tablespoonful each hour. In pulsating tinnitus, with 
 great nervous irritability, it has done me service. In one 
 case, it produced excessive irritability, and the patient aban- 
 doned it. 
 
 Pilocarpin muriate, — Politzer reports effects from this 
 salt when injected hypodermically in the mastoid. We had 
 the low potencies prepared, and obtained some decided re- 
 sults. One child, who was a deaf-mute from some acute 
 disease, has gained, by slow stages, through three months' 
 use of the remedy. At first, there was produced an extreme 
 sensitiveness to very, loud sounds ; later, a perception of 
 lower sounds, unrecognized previously ; till now, most sounds 
 are perceived, if quite loud. With this, language is return- 
 ing ; and the child now understands nearly every command 
 addressed to her, as is shown by the articles brought and 
 carried as directed. 
 
 An adult patient showed similar effects. Last May he 
 
CURED SYMPTOMS. 1 79 
 
 took a cold bath while in profuse perspiration : inside of 
 twelve hours he lost his hearing suddenly, with nausea, vom- 
 iting, dizziness on attempting to rise from the bed. After 
 confinement to the house for four or five weeks, he began 
 gradually to walk out of doors, but staggered as if intoxicated. 
 
 In October, 1884, when examined by me, his hearing for 
 the watch was c-20 R., -20 L. ; tuning-fork before ear, not 
 on bones or teeth, feels the jar ; heard bells, etc., but could 
 not distinguish voice unless very near the auricle ; heard 
 metronome 4-20 R., 2-20 L. ; he still staggered at times ; 
 tinnitus like roar of a mill, has a very depressing effect ; 
 thinks and talks of nothing else. 
 
 Muriate of pilocarpin increased the hearing, but also in- 
 creased the tinnitus : no argument would induce the patient 
 to endure the increased tinnitus for the sake of prospective 
 power. The remedies for lesions of the internal ear are so 
 few in number, that any new one will be of special interest, 
 and worthy of thorough test. 
 
 Salicylic acid and its salts, salicylate of potash, and salicylate 
 of soda, are all known to produce lesions of the labyrinth : 
 for want of a proving, we depend on reports of effects of 
 massive doses ; these are confirmed by reports of clinical 
 observations, as we find that auditory vertigo is relieved by 
 these remedies ; in one case, salicylate of soda relieved a 
 child, who had a clear history of otitis interna exudativa se- 
 rosa. (See Quinine.) 
 
 Cured Symptoms. 
 
 Mercitriiis. — Coppery odor of pus from the meatus and 
 cavity of the tympanum. Chronic inflammation and suppu- 
 ration of the drum-head. 
 
 Mercuriiis diilcis. — Closure of the Eustachian tube, with 
 the deep-red color of the mucous membrane of the posterior 
 wall of the pharynx characteristic of granular pharyngitis. 
 
 Merctirizts dulcis. — A deep-toned roaring, in cases of 
 chronic catarrh of the middle ear, with closure of the Eus- 
 tachian tube. This remedy is particularly valuable in pro- 
 
l80 LECTURES ON CLINICAL OTOLOGY. 
 
 gressive loss of hearing in old people, when it is based on 
 chronic naso-pharyngeal catarrh with granular pharyngitis. 
 
 Hepar sidph. calc. — Extreme sensitiveness of the meatus 
 and drum-head in the otitis media suppurativa chronica, with 
 perforation of the drum-head. 
 
 Iodine. — Roaring as of a mill, in case of chronic catarrhal 
 inflammation of the middle ear, such as is sometimes classed 
 as proliferous or sclerosis. 
 
 Kali imcr. — Closure of the Eustachian tube in chronic 
 suppurative inflammation of the middle ear. 
 
APPENDIX 
 
LIST OF ABBREVIATIONS. 
 
 Ab. c, Abies canadensis. 
 
 Ab. n., Abies nigra. 
 
 Abs., Absinthium. 
 
 AcaL, Acalypha indica. 
 
 Ac. ac, Acetic acid. 
 
 Acoiiin., Aconitine. 
 
 Aeon, a., Aconitum anthora. 
 
 Acoji. c, Aconitum cammarum. 
 
 Aeon./., Aconitum ferox. 
 
 Aeon. /., Aconitum lycoctonum. 
 
 Aeojz., Aconitum napellus. 
 
 Aeon, s., Aconitum septentrionale. 
 
 Aet, Actaea spicata. 
 
 Adel., Adelheidsquelle. 
 
 Adox., Adoxa. 
 
 ^5. g.^ ^sculus glabra. 
 
 y¥ls. h., yEsculus hippocastanum. 
 
 ^th., ^thusa. 
 
 A^a. cainpn., Agaricus campanulatus. 
 
 Aga. earnps., Agaricus campestris. 
 
 Aga. eit., Agaricus citrinus. 
 
 Aga. em.y Agaricus emeticus. 
 
 Aga. m.y Agaricus muscarius. 
 
 Aga. pa., Agaricus pantherinus. 
 
 Aga. ph., Agaricus phalloides. 
 
 Aga. pr., Agaricus procerus. 
 
 Aga. se., Agaricus semiglobatus. 
 
 Aga. St., Agaricus stercorarius. 
 
 Agk., Agkistrodon contortrix. 
 
 Agn., Agnus castus. 
 
 Agro., Agrostemma githago. 
 
 Ail., Ailanthus. 
 
 Aleo., Alcohol. 
 
 Aid., Aldehyde. 
 Alet., Aletris farinosa. 
 All. c.. Allium cepa. 
 All. s.. Allium sativum. 
 Aloe, Aloe. 
 
 Aht., Alstonia scholaris. 
 Alum., Aluminas. 
 Alunin., Alumen (alum). 
 Ambra, Ambra. 
 Ajubro, Ambro artemisiaefolia. 
 Ammc., Ammoniacum (gum amm.). 
 Am. ae., Ammonium aceticum. 
 Ajji. be., Ammonium benzoicum. 
 Avi. br.. Ammonium bromidum. 
 Am. car., Ammonium carbonicum. 
 Am. can.. Ammonium causticum (am- 
 monia). 
 Am. i., iVmmonium iodatum. 
 Ajh. m., Ammonium muriaticum. 
 Am. n., Ammonium nitricum. 
 Am. p.. Ammonium phosphoricum. 
 Ampe., Ampelopsis. 
 A^nph., Amphisboena. 
 Amyg., Amygdalae amarse aqua. 
 Ami. n., Amyl nitrate. 
 Ami. eh., Amylamine chlorohydrate. 
 Anac, Anacardium. 
 A nag., Anagallis. 
 Anan., Anantherum. 
 Ange., Angelica atropurpurea. 
 Angu., Angustura. 
 Anil., Anilinum. 
 Anis., Anisum stellatum. 
 
 183 
 
LIST OF ABBREVIATIONS. 
 
 Anth. n., Anthemis nobilis. 
 
 Anthr., Anthrakokali. 
 
 Ant. a., Antimonium arsenitum. 
 
 Ant. m., Antimonium mur. (chlor.). 
 
 A7iL <rr., Antimonium crudum. 
 
 A7zt. ox., Antimonium oxidum. 
 
 A7it. s., Antimonium sulf. auratum. 
 
 A7zL t., Antimonium et. potass, tart. 
 
 Apis, Apis. 
 
 Ap. g., Apium graveolens. 
 
 Aph., Aphis chenopodii glauci. 
 
 Apoc. a., Apocynum andros. 
 
 Apoc. c, Apocynum cannab. 
 
 Apom., Apomorphine. 
 
 Aq. m., Aqua marina. 
 
 Aq. p.. Aqua petra. 
 
 Aral., Aralia racemosa. 
 
 Aran., Aranea. 
 
 Aran, d., Aranea diadema. 
 
 Aran, s., Aranea scinencia. 
 
 Argem., Argemone. 
 
 Arg. c, Argentum cyanidum. 
 
 Ai'g., Argentum metallicum. 
 
 Arg. mit., Argentum muriaticum. 
 
 Arg. n., Argentum nitricum. 
 
 A^'ist. c, Aristolochia columb. 
 
 Arist. in., Aristolochia (milhomens). 
 
 Arist. s., Aristolochia serpentaria. 
 
 Am., Arnica. 
 
 Ars., Arsenicum album. 
 
 Ars. h., Arsenicum hydrogenisatum. 
 
 Ars. i., Arsenicum iodatum. 
 
 Ars. m., Arsenicum metallicum. 
 
 Ars. s.f., Arsenicum sulf. flavum. 
 
 Ars. s. r., Arsenicum sulf. rubrum. 
 
 Art. ab., Artemisia abrotanum. 
 
 Ai't. v., Artemisia vulgaris. 
 
 Arwn d., Arum dracontium. 
 
 Arnm /., Arum italicum. 
 
 Aru7H 171., Arum maculatum. 
 
 Arnm t., Arum tryphyllum. 
 
 Ai'tin. Arundo mauritanica. 
 
 Asaf., Asafoetida. 
 
 Asar., Asarum. 
 
 Asc. c, Asclepias cornuti (Syriaca). 
 
 Asc. A, Asclepias tuberosa. 
 
 Asim., Asimina triloba. 
 
 Asp., Asparagus. 
 
 Ast., Asterias rubens. 
 
 Astr., Astragalus Menziesii. 
 
 Ath., Athamanta. 
 
 Atro., Atropinum. 
 
 Anr., Aurum. 
 
 Anr. fill., Aurum fulminans. 
 
 Anr. m., Aurum muriaticum. 
 
 Aur. m. n., Aurum muriaticum natro. 
 
 Anr. J"., Aurum sulfuratum. 
 
 Bad., Badiaga. 
 
 Bals., Balsamum Peruvianum. 
 
 Bap., Baptisia. 
 
 Bart., Bartfelder (acid spring). 
 
 Bar.-ac, Baryta acetica. 
 
 Bar. c, Baryta carbonica. 
 
 Bar. m.. Baryta muriatica. 
 
 Bell., Belladonna. 
 
 Bell, p., Bellis perennis. 
 
 Benz., Benzinum. 
 
 Benz. 11., Benzinum nitricum. 
 
 Benz. ac. Benzoic acid. 
 
 Benzoin, Benzoin. 
 
 Berbn., Berberinum. 
 
 Be/'b., Berberis. 
 
 Bism., Bismuthum oxidum. 
 
 Bla., Blatta Americana. 
 
 Bol. I., Boletus laricis. 
 
 Bol. L, Boletus luridus. 
 
 Bol. s., Boletus satanus. 
 
 Bom. c, Bombyx chrysorrhoea. 
 
 Bom. p., Bombyx processionea. 
 
 Bon., Bondonneau. 
 
 Bor., Borax. 
 
 Bor. ac, Boracicum acidum. 
 
 Bot., Bothrops lanceolatus. 
 
 Bon., Bounafa. 
 
 Bov., Bovista. 
 
 Brack., Brachyglottis. 
 
 Brass., Brassica napus. 
 
 Bro., Bromium. 
 
 Brit., Brucea antidysenterica. 
 
 Brucii., Brucinum. 
 
 Bry., Bryonia. 
 
 Bnf., Bufo. 
 
 Bnf. s., Bufo sahytiensis. 
 
 Bnx., Buxus. 
 
LIST OF ABBREVIATIONS, 
 
 185 
 
 Cad., Cactus. 
 
 Cad.^ Cadmium sulfuratum. 
 
 Cad. b.. Cadmium bromatum. 
 
 Cai., Cainca. 
 
 Caj.^ Cajuputum. 
 
 Cala., Caladium. 
 
 Calc. a.y Calcarea acetica. 
 
 Calc. c, Calcarea carbonica. 
 
 Calc. can., Calcarea caustica. 
 
 Ca/c. cI, Calcarea chlorata. 
 
 Calc./., Calcarea fluorata. 
 
 Calc. I., Calcarea iodata. 
 
 Calc. m., Calcarea muriatica. 
 
 Calc. p., Calcarea phosphorica. 
 
 Calc. s., Calcarea sulfurica. 
 
 Cale., Calendula. 
 
 Calo., Calotropis. 
 
 Calth., Caltha. 
 
 Camph., C amphora. 
 
 Canc.f., Cancer fluviatilis. 
 
 Canch., Canchalagua. 
 
 Canna, Canna. 
 
 Caniiab. /., Cannabis indica. 
 
 Cannab. s., Cannabis sativa. 
 
 Caiith., Cantharis. 
 
 Cap., Capsicum. 
 
 Carb. a., Carbo animalis. 
 
 Carb. v., Carbo vegetabilis. 
 
 Carb. ac. Carbolic acid. 
 
 Carbii., Carboneum. 
 
 Carbn. cl., Carboneum chloratum. 
 
 Carbn. //., Carboneum hydrogenisatum. 
 
 Carbn. 0., Carboneum oxygenisatum. 
 
 Carbn. s., Carboneum sulfuratum. 
 
 Card, b., Carduus benedictus. 
 
 Carl., Carlsbad. 
 
 Caru., Carum. 
 
 Cary., Carya alba. 
 
 Case, Cascarilla. 
 
 Cass., Cassada. 
 
 Cast, v., Castanea vesca. 
 
 Cast, eq.. Castor equi. 
 
 Castor., Castoreum. 
 
 Cata., Catalpa. 
 
 Caul., Caulophyllum. 
 
 Caus., Causticum. 
 
 Ced., Cedron. 
 
 Celt., Celtis. 
 
 Cent., Centaurea tagana. 
 
 Ceph., Cephalanthus. 
 
 Cer. b., Cereus bonplandii. 
 
 Cer. s., Cereus serpentinus. 
 
 6Vr27., Cervus. 
 
 Cham., Chamomilla. 
 
 Chel., Chelidonium majus. 
 
 Chen, a., Chenopodium anthel. 
 
 Chen, v., Chenopodium vulvaria. 
 
 Chhn., Chimaphila. 
 
 Chin., China. 
 
 Chin, a., Chininum arsen. 
 
 Chin, in., Chininum muriat. 
 
 Chin., s., Chininum sulfuric. 
 
 Chio., Chionanthus. 
 
 ChloL, Chloralum. 
 
 Chlf., Chloroformum. 
 
 Chlo., Chlorum. 
 
 Chr. ac, Chromium acidum. 
 
 Chr. ox., Chromium oxidatum. 
 
 Chry. ac, Chrysophanic acid. 
 
 Cic, Cicuta maculata. 
 
 Cic v., Cicuta virosa. 
 
 Cich., Cichorium. 
 
 Ciinx., Cimex. 
 
 Cimic, Cimicifuga. 
 
 Cina, Cina. 
 
 Cinch., Cinchoninum sulfuratum. 
 
 Cinnb., Cinnabaris. 
 
 Cinnin., Cinnamomum. 
 
 Cist.y Cistus. 
 
 Cit. ac. Citric acid. 
 
 at. I., Citrus limonum. 
 
 Cit. v., Citrus vulgaris. 
 
 Cle., Clematis. 
 
 Cob., Cobaltum. 
 
 Coca, Coca. 
 
 Cocci., Coccionella. 
 
 Cocc, Cocculus. 
 
 Coc c. Coccus cacti. 
 
 Coch., Cochlearia. 
 
 Cod., Codeinum. 
 
 Coff., Coffea cruda. 
 
 Coff. t., Coffea tosta. 
 
 Coffn., Coffeinum. 
 
 Colch., Colchicinum. 
 
 Colchm., Colchicum. 
 
 Colocn., Colocynthinum. 
 
1 86 
 
 LIST OF ABBREVIATIONS. 
 
 Coloc, Colocynthis. 
 
 Coll., Collinsonia. 
 
 Com., Comocladia. 
 
 Conch., Conchiolinum. 
 
 Con., Conium. 
 
 Conin., Coniinum. 
 
 Conin. br., Coniinum bromatum. 
 
 Conv. a.. Convolvulus arvensis. 
 
 Conv. d.. Convolvulus duartinus. 
 
 Cop., Copaiva. 
 
 Coral., Corallium rubrum. 
 
 Cori. m., Coriaria myrtifolia. 
 
 Cori. r., Coriaria ruscifolia. 
 
 Corn, c, Cornus circinata. 
 
 Corn./., Cornus florida. 
 
 Corn, s., Cornus sericea. 
 
 Cot., Cotyledon. 
 
 Croc, Crocus. 
 
 Crot. h., Crotalus horridus. 
 
 Crot. c, Crotalus cascavella. 
 
 Crot. t., Croton tiglium. 
 
 Cry., Cryptopinum. 
 
 Cub., Cubeba. 
 
 Cnn., Cundurango. 
 
 Cupress, Cupressus Australis. 
 
 Cup., Cuprum. 
 
 Cup. ac. Cuprum aceticum. 
 
 Cup. am.. Cuprum ammonio-sulfu. 
 
 Citp. ars., Cuprum arsenicosum. 
 
 Cup. m.. Cuprum muriaticum. 
 
 Cup. n.. Cuprum nitricum. 
 
 Cup. s., Cuprum sulfur icum. 
 
 Cur., Curare. 
 
 Cyc, Cyclamen. 
 
 Daph., Daphne Indica. 
 Dat. a.. Datura arborea. 
 Dat.f., Datura ferox. 
 Dat in.. Datura metal. 
 Dat. s.. Datura sanguinea. 
 Delph., Delphinus. 
 Delphn., Delphininum. 
 Dem., Dematium petraeum. 
 Der., Derris pinnata. 
 Die, Dictamus. 
 Dig., Digitalis. 
 Dign., Digitalinum. 
 Digtx., Digitoxinum. 
 
 Dios., Dioscorea. 
 
 Dir., Dirca palustris. 
 
 DoL, Dolichos pruriens. 
 
 Dor., Doryphora. 
 
 Dro., Drosera. 
 
 Dub., Duboisia. 
 
 Dub. h., Duboisia liopwoodi. 
 
 Dul., Dulcamara. 
 
 Eaux, Eaux Bonnes. 
 
 Ech., Echites. 
 
 Elap., Elaps. 
 
 Elat., Elaterium. 
 
 El(z., Elaeis guineensis. 
 
 Emc, Emetinum. 
 
 Epi., Epilobium palustre. 
 
 Equ., Equisetum. 
 
 Ere., Erechthites. 
 
 Erig., Erigeron. 
 
 Ery. a., Eryngium aquaticum. 
 
 Ery. m., Eryngium marilinum. 
 
 Eryth., Erythrophlasum. 
 
 Erio., Eriodictyon. 
 
 Esc, Eserinum. 
 
 Eth., Ether. 
 
 Eth. n.. Ethyl nitrate. 
 
 Euc, Eucalyptus. 
 
 Eug., Eugenia jambos. 
 
 Eico., Euonymus Europseus. 
 
 Eup. per., Eupatorium perfoliatum. 
 
 Eup. pur., Eupatorium purpureum. 
 
 Euph. a.. Euphorbia amygdaloides. 
 
 Euph. CO., Euphorbia coroUata. 
 
 Euph. cy.. Euphorbia cyparissias. 
 
 Euph. h.. Euphorbia hypericifolia. 
 
 Euph. i.. Euphorbia ipecacuan. 
 
 Euph. L, Euphorbia lathyris. 
 
 Euph. p.. Euphorbia peplus. 
 
 Euphm., Euphorbium. 
 
 Euphr., Euphrasia. 
 
 Eupi., Eupion. 
 
 Fago., Fagopyrum. 
 
 Fagu., Fagus. 
 
 Fel, Fel tauri. 
 
 Fer., Ferrum. 
 
 Fer. i., Ferrum iodatum. 
 
 Fer. ma., Ferrum magneticum. 
 
LIST OF ABBKEVIATIONS. 
 
 187 
 
 Fer. mu., Ferrum muriaticum. 
 
 Fer.p., Ferrum phosphoricum. 
 
 Fe7\ s., Ferrum sulfuricum. 
 
 Fe?'. t., Ferrum tartaricum. 
 
 Fern., Ferula glauca. 
 
 FiL, Filix mas. 
 
 Fl. ac, Fluoricum acidum. 
 
 Fccn., Foeniculum. 
 
 For., Formica. 
 
 Frag., Fragaria. 
 
 Fran., Franzensbad. 
 
 Frax., Fraxinus. 
 
 Ficc, Fucus vesiculosus. 
 
 Fuch., Fuchsin. 
 
 Gad., Gadus morrhua. 
 
 Gal. ac, Gallicum acidum. 
 
 Gam., Gambogia. 
 
 Gas., Gastein. 
 
 Gau., Gaultheria. 
 
 Gel., Gelsemium. 
 
 Gen., Genista. 
 
 Geo., Geoffroya. 
 
 Gent, c, Gentiana cruciata. 
 
 Gent. I., Gentiana lutea. 
 
 Ger,, Geranium maculatum. 
 
 Get., Gettysburg. 
 
 Geu., Geum rivale. 
 
 Gin., Ginseng. 
 
 Glo., Glonoin. 
 
 Gna., Gnaphalium. 
 
 Gos., Gossypium. 
 
 Gran., Granatum. 
 
 Grap., Graphites. 
 
 Grat., Gratiola. 
 
 Grin., Grindella. 
 
 Guan., Guano. 
 
 Guara., Guarano. 
 
 Guare., Guarea. 
 
 Guai., Guaiacum. 
 
 Gynine., Gymnema. 
 
 Gymno., Gymnocladus. 
 
 HcEm., Haematoxylon. 
 Hal., Hall. 
 Ham., Hamamelis. 
 Hede., Hedeoma. 
 Hedy., Hedysarum ildefon. 
 
 Hdlia., Helianthus. 
 Helio , Heliotropinum. 
 Hell., Helleborus niger. 
 Hell.f., Helleborus foetidus. 
 Hell, o., Helleborus Orientalis. 
 Hell, v., Helleborus viridis. 
 Helo., Helonias. 
 Hep., Hepar sul. calc. 
 Hepat., Hepatica. 
 Her., Heracleum. 
 Hip., Hippomanes. 
 Horn., Homeria. 
 Hiir., Hura Brasiliensis. 
 Hydrs., Hydrastis. 
 Hydrc, Hydrocotyle. 
 Hyc. ac., Hydrocyanic acid. 
 Hydrphb., Hydrophobinum. 
 Hydrphl., Hydrophyllum. 
 Hyos., Hyoscyamus. 
 Hyosn., Hyoscyaminum. 
 Hype., Hypericum. 
 Hypo., Hypophyllum. 
 
 lb., Iberis. 
 
 Ig., Ignatia. 
 
 ///., Illicium. 
 
 Imp., Imperatoria. 
 
 Ind., Indium metallicum. 
 
 Indg., Indigo. 
 
 Intl., Inula. 
 
 lod., lodum. 
 
 lodof., lodoformum. 
 
 Ip., Ipecacuanha. 
 
 Ir.fl., Iris florentina. 
 
 Ir. fee.. Iris foetidissima. 
 
 Ir. v., Iris versicolor. 
 
 Itu, Itu. 
 
 Jab., Jaborandi. 
 
 Jac., Jacaranda. 
 
 Jal., Jalapa. 
 
 Jas., Jasrainum. 
 
 Jat., Jatropha. 
 
 Jat. It., Jatropha urens. 
 
 Jug. c., Juglans cinerea. 
 
 Jiig. r., Juglans regia. 
 
 June., Juncus. 
 
 Jtini., Juniperus Virginiana. 
 
LIST OF ABBREVIATIONS. 
 
 K. ac, Kali aceticum. 
 
 K. ar., Kali arsenicosum. 
 
 IC. bi., Kali bichromicum. 
 
 IC. br.^ Kali bromatum. 
 
 K. ca., Kali carbonicum. 
 
 A". ch7'., Kali chromicum. 
 
 A", clc, Kali chloricum. 
 
 A', ^/j., Kali chlorosum. 
 
 IC. cy.. Kali cyanatum. 
 
 K.fcy., Kali ferrocyanatum. 
 
 A". zc7^, Kali iodatum. 
 
 A". W(^., Kali hypermanganicum. 
 
 K. 11., Kali nitricum. 
 
 A"", ox.. Kali oxalicum. 
 
 A'. //'., Kali picricum. 
 
 K. sift., Kali sulfuratum. 
 
 K. slfc, Kali sulfuricum. 
 
 K. tar., Kali tartaricum. 
 
 A", tel.. Kali telluricum. 
 
 Kalvi., Kalmia. 
 
 K'ar., Karaka. 
 
 Kat., Katipo. 
 
 Kersln., Kerosolene. 
 
 A'ersn., Kerosenum. 
 
 Kin., Kino (Australiense). 
 
 Kis., Kissengen. 
 
 Kon., Kousso. 
 
 Kre., Kreosotum. 
 
 Lab., Laburnum. 
 Lace., Lacerta. 
 Lack., Lachesis. 
 Lachn., Lachnanthes. 
 Lac. ac. Lactic acid. 
 Lact., Lactuca. 
 Lam., Lamium. 
 Lap., Lapathum. 
 Lapp., Lappa, 
 Lath., Lathyrus. 
 LaiL., Laurocerasus. 
 Led., Ledum. 
 Lepi., Lepidium. 
 Lept., Leptandra. 
 Lil. s., Lilium superbum. 
 Lil. t., Lilium tigrinum. 
 LijH., Limulus. 
 Lina., Linaria. 
 Linu., Linum. 
 
 Lip., Lippespringe. 
 
 Lith. c. Lithium. 
 
 Lith. m., Lithium muriaticum. 
 
 Lob. c, Lobia cardinalis. 
 
 Lob. i., Lobia inflata. 
 
 Lob. s., Lobia syphilitica. 
 
 Lobbi., Lobelinum. 
 
 Lot., Lolium. 
 
 Lon., Lonicera. 
 
 Liif., Luff a. 
 
 Lttp., Lupulus. 
 
 Lye, Lycopodium. 
 
 Lycper., Lycopersicum. 
 
 Lycps., Lycopus. 
 
 Mac, Macrotinum. 
 
 Mag. c. Magnesia carbonica. 
 
 Mag. m., Magnesia muriatica. 
 
 Mag. s.. Magnesia sulfurica. 
 
 Magn., Magnolia glauca. 
 
 Mane, Mancinella. 
 
 Mand., Mandragora. 
 
 Mang., Manganum. 
 
 Mang. in., Maganum muriaticum. 
 
 Mang. ox., Maganum oxidatum nati. 
 
 Mang. s., Maganum sulfuricum. 
 
 Mar., Marum verum. 
 
 Mat., Mate. 
 
 Mec, Meconium. 
 
 Med., Medusa. 
 
 Mela., Melastoma. 
 
 Meli., Melilotus. 
 
 Meni., Menispermum. 
 
 Ment.pi., Mentha piperita. 
 
 Ment.pn., Mentha pulegium. 
 
 Meny., Menyanthes. 
 
 Mep., Mephitis. 
 
 Merc, Mercurius. 
 
 Merc, ac, Mercurius aceticus. 
 
 Merc, b., Mercurius bromatus. 
 
 Merc, c, Mercurius corrosivus. 
 
 Merc cy., Mercurius cyanatus. 
 
 Merc d., Mercurius dulcis. 
 
 Merc i.f., Mercurius iod. flavus. 
 
 Mei'c i. r., Mercurius iod. ruber. 
 
 Merc, m., Mercurius methylenus. 
 
 Merc, n., Mercurius nitrosus. 
 
 Merc. p. a., Mercurius precipitatus albus. 
 
LIST OF ABBREVIATIOiVS. 
 
 189 
 
 Merc. p. r., Mercurius precipitatus ruber, 
 
 Merc, sol., Mercurius solubis. 
 
 Merc, siilcy., Mercurius sulfocyanatus. 
 
 Merc, sulf., Mercurius sulfuricus. 
 
 Merl., Mercurialis. 
 
 Methln., Methylenum bichloratum. 
 
 Met/i. e. e., Methyl-ethyl ether. 
 
 Mez., Mezereum. 
 
 Mil., Millcfolum. 
 
 Mint., Mimosa. 
 
 Mit., Mitchclla. 
 
 Mom., Momordica. 
 
 Man., Monotropa. 
 
 Mor., Morphinum. 
 
 Mos., IMoschus. 
 
 Murx., Murcx. 
 
 Miir. ac, Muriaticum acidum. 
 
 Miirii., Murure. 
 
 Miisa., MuGa. 
 
 Musn., MuGcarin. 
 
 Myg., Mygale. 
 
 Myric, Myrica. 
 
 Myris.y Myristica. 
 
 A'^a. ar., Natrum arsenicum. 
 
 N'a. br., Natrum bromatum. 
 
 Na. c, Natrum carbonicum. 
 
 Na. hy., Natrum hypochlorosum. 
 
 Na. la., Natrum lacticum. 
 
 Na. m., Natrum muriaticum. 
 
 Na. n., Natrum nitricum. 
 
 Na. p., Natrum phosphoricum. 
 
 Na. sa., Natrum salicylicum. 
 
 Na. si., Natrum sulfovinicum. 
 
 Na. slfc, Natrum sulfuricum. 
 
 A^ab., Nabalus. 
 
 NaJ., Naja. 
 
 N'ap., Naphtha. 
 
 Narcn., Narceinum. 
 
 A^arcot., Narcotinum. 
 
 Narcs.po., Narcissus. 
 
 Nars. ps.. Narcissus pseudo-narcissus. 
 
 Narz., Narzan. 
 
 Nice, Niccolum. 
 
 Nico., Nicotinum. 
 
 Nit. d. s., Nitri dulcis spiritus. 
 
 Nit. ac, Nitricum acidum. 
 
 A^it. fii. ac, Nitro muriatic acid. 
 
 A7/. ox., Nitrogenium oxygenatum. 
 
 yV/Vr., Nitrum. 
 
 A'lcp., Nuphar lutcum. 
 
 A'x. ni., Nux moschata. 
 
 A^x. v., Nux vomica. 
 
 Aym., Nympheea odorata. 
 
 Oci., Ocinum. 
 
 Ocna., Oenanthe. 
 
 Oeiio., Oenothera. 
 
 Olnd., Oleander. 
 
 01. an., Oleum animale. 
 
 01. j., Oleum jecoris aselli. 
 
 Oni., Oniscus. 
 
 Op., Opium. 
 
 Opl., Oplia. 
 
 Opit., Opuntia. 
 
 Ori., Origanum. 
 
 Osni., Osmium. 
 
 Ost., Ostrya. 
 
 Ox. ac, Oxalicum acidum. 
 
 Ox CO., Oxcodaphne. 
 
 Ozo., Ozonum. 
 
 Paeo., Paeonia. 
 
 Pal., Palladium. 
 
 Pan., Panacea. 
 
 Pap., Papaverinum. 
 
 Par., Paris quadrifolia. 
 
 Pas., Pastinaca. 
 
 Pail, p., Paullinia pinnata. 
 
 Pau. s., Paullinia sorbilis. 
 
 Pb.^ Plumbum. 
 
 Pb. ch.. Plumbum chromicum. 
 
 Ped , Pediculus. 
 
 Pen., Penthorum. 
 
 Per., Persica. 
 
 Peti., Petiveria. 
 
 Petrol., Petroleum. 
 
 Petros., Petroselinum. 
 
 Phal., Phallus. 
 
 Phas., Phaseolus. 
 
 Phc, Phellandrium. 
 
 Pho., Phosphorus. 
 
 Pho. ac, Phosphoricum acidum. 
 
 Pho. h., Phosphoricum hydrogenatus. 
 
 Physa., Physalia. 
 
 Physo., Physostigma. 
 
IQO 
 
 LIST OF ABBREVIATIONS, 
 
 Phyt., Phytolacca. 
 
 Pic. ac, Picricum acidum. 
 
 Picro., Picrotoxin. 
 
 PH., Pilocarpinum. 
 
 Piine., Pimcnta. 
 
 Pimp., Pimpinella. 
 
 Pin. c, Pinus cupressus. 
 
 Pin. I., Pinus lambertiana. 
 
 Pi)i. s., Pinus sylvcstris. 
 
 Pip. ni., Piper mcthysticum. 
 
 Pip. n.. Piper nigrum. 
 
 Pis., Piscidia. 
 
 Pix., Pix liquida. 
 
 Plan., Plantago. 
 
 Plat., Platinum. 
 
 Plat, in.. Platinum muriaticum. 
 
 Pie., Plectranthus. 
 
 Plunibg., Plumbago littoralis. 
 
 Pod., Podophyllum. 
 
 Polyg., Polygonum. 
 
 Polyp, o., Polyporus officinalis. 
 
 Polyp, p., Polyporus pinicola. 
 
 Pop., Populus. 
 
 Pot., Pothos. 
 
 Pri., Prinos. 
 
 Pro., Propylaminum. 
 
 Pru.p., Prunus padus. 
 
 Prti. s., Prunus spinosa. 
 
 Pso., Psorinum. 
 
 Pte., Ptelca trifoliata. 
 
 Pill., Pulsatilla. 
 
 Pill. 71., Pulsatilla nuttalliana. 
 
 Pyrth., Pyrethrum. 
 
 Pyriis, Pyrus. 
 
 Qua., Quassia. 
 
 Ran. a.. Ranunculus acris. 
 
 Ran. b.. Ranunculus bulbosus. 
 
 Ran. g.. Ranunculus glacialis. 
 
 Ran. r., Ranunculus repens. 
 
 Raji. s.. Ranunculus sceleratus. 
 
 Rap., Raphanus. 
 
 Rat., Ratanhia. 
 
 Rei., Rcinerz. 
 
 Res., Resina itu. 
 
 Rha. c, Rhamnus catharticus. 
 
 Rka.f., Rhamnus frangula. 
 
 R/ie., Rheum. 
 Rhodi., Rhodium. 
 RJiodo., Rhododendron. 
 Rhu. g., Rhus glabra. 
 Rhii. t., Rhus tox. 
 RJm. v., Rhus venen. 
 Ric., Ricinus. 
 Rob., Robinia. 
 Ros., Rosmarinus. 
 Rum. a., Rumex acetosa. 
 Rum. c, Rumex crispus. 
 Riis., Russula. 
 Rut., Ruta. 
 
 Saba., Sabadilla. 
 
 Sabi., Sabina. 
 
 Sac., Saccharum album. 
 
 Sain., Salicinum. 
 
 Sal. ac, Salicylicum acidum. 
 
 Sal. n., Salix niger. 
 
 Sal. p., Salix purpurea. 
 
 Sam., Sambucus. 
 
 Sam. c, Sambucus canadensis. 
 
 Sang., Sanguinaria. 
 
 Sant., Santoninum. 
 
 Sap., Saponinum. 
 
 Sarr., Sarracenia. 
 
 Sars., Sarsaparilla. 
 
 Sea., Scammonium. 
 
 Sch., Schinus. 
 
 ScoL, Scolopendra. 
 
 Scor., Scorpio. 
 
 Scr., Scrophularia. 
 
 Sen., Scutellaria. 
 
 Sec. c, Secale cornutum. 
 
 Sed., Sedinha. 
 
 Sel., Selenium. 
 
 Senec, Senecio. 
 
 Seneg., Senega. 
 
 Senn., Senna. 
 
 Sep., Sepia. 
 
 Ser., Serpentaria. 
 
 Sil., Silicea. 
 
 Sin. a., Sinapis alba. 
 
 Sin. n., Sinapis nigra. 
 
 Sill., Slum. 
 
 Sobim., Solaninum. 
 
 Sol. a., Solanum arrebinta. 
 
LIST OF ABBREVIATIONS. 
 
 IQI 
 
 Sol. m., Solanum mammosum. 
 
 Sol. Ti., Solanum nigrum. 
 
 Sol. 0., Solanum oleraceum. 
 
 Sol. p., Solanum pseudo-capsicum. 
 
 Sol. t., Solanum tuberosum. 
 
 Sol. t. a., Solanum tuberosum cegrotans. 
 
 S_pig., Spigelia. 
 
 Spjg. 7n., Spigelia marilandica. 
 
 ^AT-> Spiggurus. 
 
 Spira.^ Spiranthes. 
 
 Spire., Spirea ulmaria. 
 
 Spo., Spongia. 
 
 Sqii.j Squilla. 
 
 Stack., Stachys betonica. 
 
 Stan., Stannum. 
 
 Stap., Staphisagria. 
 
 Stic, Sticta pulmonaria. 
 
 .5"///., Stillingia sylvatica. 
 
 Stra??i., Stramonium. 
 
 Stro., Strontium. 
 
 Stry., Strychninum. 
 
 SiiL, Sulfur. 
 
 Sul. h., Sulphuretted hydrogen. 
 
 Sul. i., Sulfur iodatum. 
 
 Stil. ac, Sulfuricum acidum. 
 
 Sulphs. ac. Sulphurous acidum. 
 
 Slim., Sumbul. 
 
 Syph., Syphilinum. 
 
 Tab., Tabacum. 
 Tana., Tanacetum. 
 Tang., Tanghinia. 
 Tann., Tannin. 
 Tarax., Taraxacum. 
 Tarent., Tarentula. 
 Tart, ac. Tartaric acid. 
 Tax., Taxus baccata. 
 Tel., Tellurium. 
 Tep., Teplitz. 
 Ter., Terebinthina. 
 Tet., Tetradymite. 
 Thai., Thallium. 
 Thea, Thea. 
 Ther., Theridion. 
 Thev., Thevetia. 
 Thu., Thuja. 
 Til., Tilia. 
 Tit., Titanium. 
 
 Ton., Tongo. 
 
 Toxa., Toxicophloea. 
 
 Toxs., Toxicophis. 
 
 Trac, Trachinus. 
 
 Trad , Tradescantia. 
 
 Trif. p., Trifolium praetense. 
 
 Trif. r., Trifolium repens. 
 
 Tril., Trillium cernuum. 
 
 Trini., Trimethylaminum. 
 
 Trio., Triosteum. 
 
 Trom., Trombidium mus. domes. 
 
 Tus.f., Tussilago fragrans. 
 
 Tus. p., Tussilago petasites. 
 
 Upa., Upas. 
 
 Ura., Uranium nitricum. 
 
 Ure., Urea. 
 
 Urt. c, Urtica crenulata. 
 
 Urt. g., Urtica gigas. 
 
 Urt. u., Urtica urens. 
 
 Ust., Ustilago. 
 
 Uva, Uva ursi. 
 
 Vac, Vaccininum. 
 
 Val., Valeriana. 
 
 Verat., Veratrum album. 
 
 Verat. v., Veratrum viride. 
 
 Veratn., Veratrinum. 
 
 Verb., Verbascum. 
 
 Vesp., Vespa. 
 
 Vich., Vichy. 
 
 Vin., Vinca. 
 
 Vio. 0., Viola odorata. 
 
 Vio. t., Viola tricolor. 
 
 Vip., Viper a. 
 
 Vip. I./., Vipera lachesis fel. 
 
 Vise, Viscum album. 
 
 Vds., Voslau. 
 
 Weis., Weisbaden. 
 Wild., Wildbad. 
 Wye., Wyethia. 
 
 Xan., Xanthoxylum. 
 
 Yiic, Yucca. 
 
192 
 
 LIST OF ABBREVIATIONS. 
 
 Zing., Zingiber. 
 
 Z/2., Zizia. 
 
 Zn., Zincum. 
 
 Zii. a., Zincum aceticum. 
 
 Zn. c.f Zincum cyanatum. 
 
 Zn.f., Zincum ferrocyanatum. 
 Zn. in., Zincum muriaticum. 
 Zn. p., Zincum phosphoratum. 
 Zn. J., Zincum sulfuricum. 
 
EAR: GENERAL, 
 
 [Note — As has been said in the preface, this repertory' Is not my ideal, but may prove a 
 stepping-stone to a better. In the classification of symptoms under anatomical subdivisions, the 
 attempt has been made to place symptoms in their proper physiological relations. This may be a 
 matter of uncertainty in some instances, on account of faulty expression, or lack of knowledge of 
 exact functions, as now understood. This effort may not commend itself to those who care only 
 for symptoms, but it will be appreciated by those who labor to link symptom and function. 
 
 The author will be pleased to have his colleagues report any corrections or additions, that they 
 may be noted for future reference. The emphasis placed upon remedies is marked by three degrees, 
 — in small type, Italics, and capitals.] 
 
 Ear, Aching. All. c, Aloe, Anac, Arn., Asa/., Asaf, (r.), Asar., Astac, Aur., 
 Bar. c, Bell., Bell. (1.), Bor., Bism., Bro. (r.), Bry., Calc. cau., Cannab. i., 
 Canth., Cap., Caus., Cham., Cimic, Cinch., Cle., Coc. c, Coloc, Con., Cup., 
 Dig., Ery. a. (1.), Euphr., Fl. ac, For., Grap., Guai. (L), Ham., Hell., Hyos., 
 Ig., Indg., lod., Ip., Jat., Jug. (r.), K. ca., Lach., Lact., Lau., Lith. (1 ), Lob. i., 
 Lye, Mag. c, Mang , Mang. (1.), Merc, Merc. i. r., Merl., Mez., Mez. (1.), 
 Mur. ac, Xa. m. (1.), Xx. m., X*.x. v., Olnd., Osm., Petrol., Pho., Pru. r., 
 Pso. (r.), Ran., Rhu. t.. Rum. c. Rut., Saba., Sabi., Sars., Seneg., Sep., Sil., 
 Spig., Spo., Stan., Stap., Sul., Sul. (1.), Sul. ac, Tab., Tarent., Thu., Ust., 
 Verat., Verb., Vio. o.; morning, in bed, Merc i. r.; on rising, Fer. ; > taking 
 wax from ear, Calc. s. (1.); afternoon, Euph. (r.) ; evening, Berb. (r.), 
 K, bi., Lye. (1.), Na. m. ; i P.M., Mit. (r ) ; 2 P.M., Pau. p. ; 5 P.M., Ham. (r.) ; 
 from being in open air, Sep. ; after midnight, Sep. ; after walking in wind, 
 S<Q]y. (r ) ; NIGHT, Ditl. ; in open air, Euphm., Lye; on blowing nose, 
 Sil. (1.); before breakfast, Stach. ; at every COUGH, Cap.; after lying 
 down. Sang. ; during menses. Aloe ; (amel.), pressure. Ham. (r.) ; entering 
 warm room, 5 P.M., Sep. ; removing wax, Calc. s. (1 ) ; with hard hearing, 
 Ip.; shooting. Lob. i. (r.) ; acute, Olnd.; as if BURNT, extending oulrvvard 
 into ear, Bry. (1.) ; in children. All. c. Bell., Cham., Big., Merc, Pul., 
 RJui. t., ZN. (boys?); DRAWING, on approach of thunderstorm, or cloudy, 
 windy weather, Rhodo. ; extending to finger-ends. Ham. ; to jaw, on least 
 dampness, Itu. ; from 1. to r., Calc. ph. ; to malar bone and molar [Spig.]; (r.) ; 
 into parotid gland and mastoid process, when walking in wind, > warmth, 
 5 P.M., Sep. ; outward, walking in cold wind, 4.30 P.M., Sep. ; into teeth, 
 Hydrphb., Xan. (r.). 
 Air in, sensation of. Mez. (r., then 1.). 
 
 193 
 
194 EAR: GENERAL. — BAR. — BURROWING, 
 
 Bar through jaws from ear to ear, sensation of. Hur. 
 
 Beating. See Pulsation. 
 
 Biting. Pso. (1.) ; like electric sparks here and there, 8 to lo p.m., Phe. 
 
 Blood rushing into. Gel., Hydrphb , Lye, Pul.; sensation of hot, Lye. 
 
 Blow, pain as from. Ail. (r.), Anac, Arn., Bell., Con., Nx. v., Ol. an., Rut, 
 Spig., Verat. ; extending inward, Bell. ; outward. Con. 
 
 Blowing, pulsative, at night. Sep. (r.). 
 
 Board before, sensation of. Arg. (1.). 
 
 Boil. K. ca. ; sore, Spo. (1.). 
 
 Boring. Alum, Am. car., Aur., Bar. c, Bar. c. (r.). Bell., Berb., Cannab. i. 
 (r.), Canth. (L), Carb. a., Carb. a. (r.), Carbn. s. (r.). Cans., Caus. (r.). Cup., 
 Cup. ac. (r.), Euphr., I/e//., Indg., K. ca., K. iod., Lau., Lepi., Mag. c, Mag. 
 c. (r.), Mag. m., Mag. m. (r.), Mag. s. (1.), Merc. i. f., Mil., Na. m., Ol. an., 
 Phe., Plat., Pb., Ran. s., Rhodo., Saba., SiL., Spig., Stan., Stan, (r.), Sul., Sul. 
 (< r.), Thu. ; MORNING, Alum. ; forenoon, Mag. c. (1.) ; afternoon, Alum. ; 
 after dinner, Pb. (r.); on pressure, Alum.; with sticking, Mag. m. ; 
 ticking, Nice (r.) ; boring behind ear. Cup. ; acute, Merc. i. f. (1.); has to 
 , scream. Bar. c. ; as if something wanted to come out. Am. m., Iod. ; deep- 
 seated, Aur. m. n., Merc. i. f. (1.), Phe.; extending inward. Am. m., Mag. 
 c. ; with stitches, Mag. c. ; to jaw, Phe. ; outward. Am. m. (r.), Aur. m., Merc, 
 i. f., Merc. i. f. (1.); towards parietal bone and temple in afternoon, Indg. ; 
 obtuse, Mag. c. 
 
 Bruised feeling. Am. car., Stry. 
 
 Burning. Aeon., yEs. h., Aga. m.. Aloe, Alum., Ami. n.. Am. m., Angu., 
 Ant. cr.. Ant. cr. (1.), Arn., Arum t. (r.), Ars., Asaf., Aur., Aur. s., Bell , Berb., 
 Bro., Bry., Calc. ostr., Camph., Cannab. i., Carb. a., Carb. v.. Case, Caus., 
 Chel., Chin., Cle., Cyc. (r.), Daph., Dig., Dro., Dro. (r.), Fago. (1.), Grat., 
 Ig., Jat., Kre., Lau., Lil. s.. Lob. s., Lye, Lycps. (r.), Mag. c, Mag. c. (r.), 
 Mag. m., Merc, Merc, (r.), Merc, sol., Naj., Na. m., Nitr., Olnd., 01. an,, 
 Pho. ac. Pic. ac. Plat., PuL., Ran. b., Rhu. t., Saba., Saba, (r.), Sabi., Sang., 
 Sars., Spig., Spire., Spo., Stap., Stry., Tab., Tarax., Tel., Tel. (1.), Ter., Til., 
 Zn. ; noon, Stry.; afternoon, Stry. (1.); evening, Bro. (1.), Ham. (r.), 
 Zn.; 1.40 P.M., Equ. (r.) ; 2.30 P.M., Jug. (r.); at NIGHT, Stry.; before going 
 to sleep, Stil. (1.); after rubbing, Grat. (r.) ; on touch. Cop. (1.); from 
 DRY warmth, Bry.; while yawning, < open air, in evening, > after eating. 
 Aeon.; > pressure, Ham. (r.) ; with purulent bloody discharge, Pul.; 
 otitis, Kre., Nitr. ; heat in head, Jat. ; heat in face after a chill, Tarent. ;■ red 
 cheeks. Sang. ; hot stage. Ran. b. ; sweat. Aeon. (1.) ; followed by hard 
 hearing. Cap. ; as from a hot coal, Bro. ; as from coming from cold into 
 a warm room, K. n. ; deep-seated, Merc. sol. (<1.) ; like electric sparks, 
 8 to 10 p.m., Phe.; extending inward. Am. m. : down angle of jaw, Bov. 
 (r.) ; outward, Aur. m., Sep. ; 5.30 p.m. on walking in open air. Am. m. (1.) ; 
 like fire, Mag. c. ; as if frost-bitten, Aga. m. ; internally, as from a red- 
 hot coal, Tep. (r.) ; painful, with purulent and bloody discharge, Chin., Sul. 
 
 Burrowing sensation, as of animals, < lying still. Ant. cr.; in ear on which 
 he lies at night as if something would come out. Am. m. (r.) ; conges- 
 tive, extending to lower jaw, Am. c (1.) ; extending to side of neck, clavic- 
 ular region, last back teeth, and side of occiput, Coc c (1.). 
 
EAR : GEXERAL. — B URSTIXG. — DISTEXDED. 1 95 
 
 Bursting sensation. Ami. n., Calc. can. (1.), Caus., Lye, Xit ac, Pho. ; with 
 each beat of the heart, Ami. n. ; as of a leaflet, in evening. Gam. 
 
 Catarrh. Bar. m. 
 
 Closed sensation. Lachn., Merc. i. f. (r.). Nit. d. s. (1.), Pul. n. (1.), Spig.; 
 MORNING, Bro. (r.) ; in open air from wind blowing, Spig ; with stitches, 
 Glo. ; ALTERNATELY, as if closed and deaf, Cocc. ; as if deaf, Xit. ac. ; 
 though hearing well, Merc. i. f. (r.) ; OPENING with a dull (dead) sound, 
 Mar. ; SUDDEN, Tanac. 
 
 Coldness. Amyg., Ars., Berb. (1.), Calc. c, Calc. ph., Chel. (r.), Cic. v., Dul., 
 K. ca., Lach., Lye, Mang., Mang. (r.), Meny., Merc, Plat., Pso. (r.), Seneg., 
 Stan., Stap., Tel., Ter. (1.), Verat. v. ; evening, Mez. • 5 p.m., Paeo.; 
 in WARM bed, Merc. sol. ; with bubbling sound, Berb. ; numbness extend- 
 ing to cheeks and lips, Plat. ; pulsation, Berb. ; twitchings, Plat. ; alter- 
 nating with heat, Verat. (r.), of external ear, Verat. ; as after taking cold, 
 Wild. ; extending through ear, Seneg. (1.) ; as if water had got in, Meny. 
 
 Compression. Sars. 
 
 Congestion. Aloe, Coloc, Fl. ac, Glo., Hyos., Xx. rn., Pul.; with gastric 
 symptoms, Tarent. 
 
 Constriction. Thu. (r.) ; pain as if constricted internally. Dig. 
 
 CoNTR-VCTiON. Anac, Asar., Bry., Caus., Croc, Dig., Dro., Lach., Merc, 
 Sars., Sars. (r.), Spig., Spo., Thu.; with shocks, Bell.; spasmodic, after- 
 noon, when sitting, .'Eth. (r.) ; sensation of, evening, after lying down, < 
 sleeping on that side, Caus. (1.). 
 
 Cramp. Aga. m. (1.), Aloe, Ambra, Anac, Angu., A7-n., Ars., Asar., Bell., 
 Calc. can., Calc. ostr., Carb. a., Carb. v., Caus., Cham., Chin., Cina, Cle., 
 Coc c, Colch., Coloc, Con., Croc, Crot. t., Dig., Dro., DuL, Euphm., Gran., 
 Grap., Hell., lod., K. ca., K. n., Kre., Lye, Mang., Mar., Meny., Merc, Merc, 
 sol., Miir. ac. (1.), X"a. c, Xa. m. (1.), Xit. ac, A'x. m., Xx. v., Olnd., Par., 
 Petrol., Pho., Pho. ac. Plat., PuL., Ran. b., Ran. s., Rhe., Rhodo., Rhu. t., 
 Saba., Sam. (r.), Sep., Sil., Spig., Spo., Stan, (r.), Stram , Stap., SicL, Thu., 
 Verat., Verben., Zn. ; evening, Thu. (r.) ; on walking in open air, Spo. 
 (1.); FOLLOWED by stitches, Thu.; internally and externally, in 
 evening, Ran. b. (1.). 
 
 Crawling. Ars., Cinch., Colch., Dul., Grat., Lau. (1.), Mang., Meny. (1.), 
 Mep. (1.), Merc, Spo., Sul., Sul. ac. ; with tearing, Zn. ; deep-seated, Lau. ; 
 disturbing night's rest, Xx. v. ; painful, like digging, going after a while 
 to lower jaw. Am. car. (1.). 
 
 Creeping, with tearing. Sul. ac, Ton. 
 
 Cutting. Arg., Bell., Canth., Coloc, Mur. ac, Petrol., Petrol. (1.), Sil.; 
 extending inward, Agn., Bell. ; outward, Astac. 
 
 Darting. Glo., K. iod. (r.), Kalm., Lepi., Rhodo. (1.) ; while yawning, < 
 evening or in open air, > after eating, Aeon. ; acute, Stry. ; extending to 
 shoulder, Lepi. 
 
 Digging. Am. car., Am. m., Ant. cr., Colch. (r.), Gel., Gel. (r.). Hell., Plat.; 
 afternoon, Gel. (r.), Merc. (1 ) ; with hard hearing, Jac ; deep in, Stry. 
 (1.) ; extendtng to nostril, with noise and hard hearing, Jac. ; to lower jaw, 
 Am. car. ; as from insects, K. iod. 
 
 Distended sensation. Bell., K. iod., Lau. (r.), X'it. ac, Pul. 
 
g6 EAR: GENERAL. — DIVING. — HEAT. 
 
 Diving, sensation as when, while writing. Rap. 
 
 Dra'gging, downward, Berb. (r.); outward, Caus., Euphr. ; 4 p.m.. Cane, f . ; 
 pulsating, > stooping, Cannab. s. 
 
 Drawing (including Pulling). Acon.,"Angu. (r., then 1.), Aur. m. {r.),Bar. 
 c, Bell., Berb., Bov., Bry. (r.), Calc. c, Carb. a., Caus. (r.), Chel. (1.), Coc. c, 
 Con. (1.), Crot. h., K. ca., Lye, Mag. m., Merc, sol., Mez. (1.), Mil. (1.), Mos. 
 (r.), Na. m. (r.), Nice, Nit. ac. (r.). Op., Petrol., Pul. n., Rhodo., Sep. (r.), 
 Sil., Stan. (1.), Stap., Sul. (r.). Verb. (1.); at night, Bar. c; with stopped 
 feeling, Lach. ; from taking cold, Glo. (r.) ; after lying down, Sul. (r.) ; on 
 MOTION OF LOWER JAW, Stan, (r.) ; on PRESSING posterior part. Rap. ; 
 > SNEEZING, Mag. m. ; acute, Pho. ; alternately, Lact. ; as from taking 
 COLD, Til (1.) ; CONTRACTIVE, Croc. (r.) ; CRAMPY, Crot. c. (r.). Petrol., Sil. 
 (r.), Val. (1.); deep-seated, Ost. ; dull, extending inward, Dro. (r.) ; ex- 
 tending to forehead, Dign. (1.); inward, Dro., Nx. v.. Verb. (1.); towards 
 malar bone, Spig. (1.) ; into neck. Bell., Sil. (r.) ; to shoulder-joint, Na. m. ; 
 outward, Pul. n. ; to teeth, Mos. (r.) ; Chel. (1.) ; to vertex, Arn. (1.), fore- 
 noon. Gam. (r.) ; to zygoma, Hype. (1.) ; sensation as if something were pulled 
 from shoulder, Lepi. ; internally, Spo. (r.), and externally, Stan, (r.) ; 
 SPASMODIC, Pho. ac. ; stupefying, Asar. ; tearing, Plat. ; twitching, 
 Plat. (1.). 
 
 DuLNESS. Chel., Chlo. (1.). 
 
 Enveloped or stopped, sensation as if. Bor. 
 
 Eruption, crusty, and on cheek. Elap. 
 
 Falling to and fro, something seems, with clucking, Grap., and bursting, 
 then singing, Saba. ; sensation of something falling on the floor, and crack- 
 ing, with, and followed by, rushing, Saba. 
 
 Planning before, sensation of. Calc. c. (1.). 
 
 Flapping. Calc. c. ; like butterflies' wings, 8 a.m., Jac. 
 
 Forcing. Spo. ; as of brain through skull, Na. m. ; as if something were for- 
 cing out, Merc, sol., Pul. ; towards ears, Lye. 
 
 Formication. Ambra, Bar. c. (1.), Calc. c. (r.), Caus. (1.), Coloe., Cop., Der., 
 Dro. (1.), Grat., K. ca., Lau., Mere. sol. (1.), Mil. (1.), Nx. v.. Plat., Physo., 
 Rat. (r.), Sam., Sep. (r.), Sul. ac. (1.), Tong. (r.) ; in morning, Zn. ; while 
 eating, Lachn. ; extending to lower jaw. Am. c. (1.); fine, Na. m. (r.) ; 
 itching, Spig. (r.) ; tickling. Chin. 
 
 Fulness, ^s. h., Berb. (r.), Bon., Cannab. i.. Dig., Eup. pur., lod., Fer., 
 Glo., Jug. (r.), Na. ph., Na. slfc. Pen., Physo., Stry., Verat. v. (1.) ; morning, 
 Thu. (r.); 8 A.M., Ham. (1.); afternoon, Stry.; evening, Na. ph.; after 
 stitches leave it, lod.; < excitement, Dig.; with pain, Berb.; fulness 
 around ears, Glo. 
 
 Gnawing. Arg., Dro., Indg., K. ca. (1.), K. iod. (1.), Mur. ac, Pho., Sul., 
 Sul. (1.), Tab., Tab. (r.); afternoon, > rubbing, Indg. (1., then r.) ; evening, 
 Mur. ae. (r.). 
 
 Griping. At night on waking. Carbon, s. (1.). 
 
 Gurgling. > boring with finger. Castor, (r.) ; with increased earwax, K. ca. 
 
 Heat. Aeon., Aloe, Alum., Ami. n. (1.), Angu., Arn., Ars., Asaf., Asar., Aur. 
 m. n.. Bell., Bon., Bro. (r.), Bry., Calc. c, Calc. astr., Calc. ph., Canna, Canth., 
 Carl, Case, Caus., Cham., Cle., Cic. v., Coloc. (r.), Coc. e. (1.), Crot. h., 
 
EAR: GENERAL. — HEAT. — ITCHING. 1 97 
 
 Fago. (1.), Gas., Grap., Hep., Ign., lod., Jac, Jat, K. ca., Kis., K. n., Kre., 
 Lach., Lye, Mag. m. (r.), Mane, Mang. (1.), Meny., Merc, Mur. ac, Na. m., 
 Nit. ac, Nit. ox., Nx. v., Ol. an., Oena., Paeo., Pau. p.. Par., Peti., Petrol., Pho. 
 ac, Pho., Plat., Pso. (r.), Pid., Rap., Rhode, Sabi., Seneg. (r.), Sep., Sep. (r ), 
 Sil., Spo., Sul. ac (r.), SuL, Tab., Tarent. (r.), Ter. (r.), Thu. (r.). Til. (r.), 
 Verat, Wild, (r.), Zn., Zing.; at 10 a.m., Pip. m. ; afternoon, Cannab. s. ; 
 after drinking coffee, Na. m. (r.) ; EVENING, Ahtm., Cap., Card. v. (1.), 
 Na. m. {!.), Na. n., Sabi.; 4 p.m., Ped. ; 10 p.m., Stry. (1.); midnight, > 
 going to sleep, Alumn. ; NIGHT, before falling asleep, Sul.; when lying 
 DOWN, Ars., Hype.; with burning and hard hearing, Jac; itching, Nit. ac. ; 
 otitis, K.ca. (r.) ; painful sensations, Petrol.; drawing pain, Sep.; digging, 
 burning pain extending to left nostril, Jac. ; pressure in occiput, Gran.; 
 chill, Pul., in back, Asaf., in upper arms, Ig.; coldness of body. Aeon. ; pleas- 
 ant warmth, Mag. m. ; alternating with coldness, Verat. (r.) ; drawing, 
 Lach. ; like hot blood, Calc c ; extending from ears, Olnd., Sep.; over 
 half of head, Chel. (1.) ; to angle of jaw, Bov. (r.) ; over occiput to nape of 
 neck, Spo. ; to pharynx, evening while riding, Nx. m. ; external, with twitch- 
 ing, Pul.; internal, Arn. ; as if near a stove, Ant. t. (1.). 
 
 Heaviness. Gel., Glo. ; before menses, Crot. h. ; in and before ears, with a 
 stopped sensation, Carb. v., with hard hearing, Carb. v. 
 
 Hollow sensation in morning, > after dinner, Nx. v. 
 
 Ice within, sensation of, in warm bed. Merc. sol. 
 
 Inflammation. Acon., Aloe, Ant. cr., BelL, Bor., Be-tzn.^ Cad., Calc ostr., 
 Cannab. i., Canth., Carb. v., Cham., Cist., Cocc.^ Coloc, DtcL, Fer., Fl. ac, 
 Gel., Glo., Hep., K. ca., Kre., Lyc, Mane, Mag. c, Mag. m., Merc, Merc, s., 
 Na. m., Nitr., N'x. v,, Par., F/io., Pho. ac, Pte. (r.), Pul., Pul, n., Rhu. t., Rhu. 
 v., Sang., Sep., Sil., Spo., Sul., Tel., Thu., Ulmus c, Zn. ; with anguish. 
 Bell.; burning, Kre., Nitr.; constant buzzing, Merc; caries of ossicula, 
 Lyc, Sil., Sul. ; great distress from noise, Merc. ; partial deafness, Merc. ; 
 discharge of pus. Bell.; increased hardness of hearing, Thu.; heat, K. ca. (r. ) ; 
 itching, Nitr.; pain. Bell.; agonizing pain when going to bed, lasting until 
 morning, Merc; ulcerative pain, Mag. c ; violent pain, Pul. ; pyaemia, Pho. ; 
 redness, Kre., Mag. c ; sensitiveness, Mag. c, intense, and of adjoining 
 parts, Merc. ; soreness in meatus, Merc. ; jerking, starting, Nitr. ; stitches, 
 Alum. (I.), Merc, Merc, c ; suppuration in meatus externus. Kin. ; swelling, 
 Kre., Nitr. ; swelling in meatus, Calc. ostr., Cist., K. ca., Na. m., Sep., Tel., 
 Thu., Zn. a., and purulent discharge, Pul.; swelling around ear, Pul.; pain- 
 ful and considerable swelling of mastoid process, Merc. ; tearing, Merc. ; 
 delirium. Bell., Pul.; tensive pain in head, Bell.; sometimes paleness, some- 
 times flushed face, Kalm. ; great thirst, Pul.; vomiting. Bell.; costiveness, 
 Pul.; aphonia. Bell., Rhu. t. ; fainting-fits. Bell.; coldness of limbs. Bell.; 
 periodical, Rhu. v. 
 
 Itching. Aeon., Ambra, Aga. m.. Alum., Am. m., Aiiac, Apis (r., then 1.), Aq. 
 p., Arg., Arg. (1.), Bar.c, Bell., Benz. ac (1.), Berb., Brach., Bov., Bry., Calc 
 c (1.), Calc. ostr., Calc. p.. Cap., Carb. a. (r.). Carb. v., Carl., Cans. (1.), Cent., 
 Chel. (r.), Cinnb., Coc c (1.), Con., Cup., Cyc, Elap., Fago. (1.), Fl. ac. (r., 
 thenl.), For. (1.), Grap., Grat., Ham. (1.), 7%/., Ig., K.ca., K.iod., K. iod. (1.), 
 K. n., Kre., Lach., Lachn., Lau., Lau. (r. and 1.), Lep., Lip., Lyc, Mang. (!.>, 
 
[qS EAR: GENERAL. — ITCHING. — LACERATION. 
 
 Meny. (r.), Mep. (r.), Merc. i. r. (r.), Merc, sol., Mez. (r.), Mil. (r.), Mos., 
 Mur. ac. (r. and 1.), Na. m. (r.), Na. slfc. (1.), Nit. ac, Nitr., Nx. v., Ol. an., 
 Paeo., Ped., Ped. (r.), Petrol., Petrol. (1.), Phel., Phel. (r.), Pho., Pho. ac, 
 Pso. (r.), Pul. (r.), Rat. (r.), Rhe., Rhodo., Rhodo. (1.), Rhu. t. (1.), Rum. c. 
 • (r.), Sam., Sars., Sars. (1.), Sed. (1.), Sel., Sep., Sil. ( < L), Spig., Stan. (1.), 
 Stry., Sul. (1-.), Sul, i., Tarax., Tarent. (r.), Tel. (1.), Ton. (r.), Verat. v. (1.), 
 Vio. t., Wies., Wyeth., Zn. (1.) ; in MORNING, Na. c, Mag. m. ; afternoon, 
 Aga. m. (1.), Arg., Pul.; evening, Aeon., Arg., Cala. (r.), Dios., Grap. (1.), 
 Ol. an., Ped. (1.), Pte. (r.), Pul.; when walking, Bor. (1.) ; 2.30 p.m., Grat. 
 (r.); 3 P.M., Lau., 4 P.M., Ol. an., 5 p.m., Fago. (1.); 6 p.m., Pte. (r.) ; 8 
 P.M., 01. an.. Rum. c. (1.) ; night, Merc, i.f., Sep. (r.), Stry.; after oozing 
 of LYMPH, Grap.; on RISING, Trom. ; while yawning. Aeon.; (agg.), even- 
 ing, Aeon., Na. m. ; in open air, Aeon.; on gasping, Aeon.; rubbing. Alum., 
 scratching. Ton. ; stooping, Lepi. ; going from cold air into warm room, 
 Coc. c. ; (amel.), rubbing, Mez., Phe. ; scratching. Am. m.. Cans., Chel., 
 Lau., Na. slfc. (r.); touch, Na. m. ; with buzzing and roaring, Sep. ; dis- 
 charge, Anac, Bar., Merc, Petrol., Sep.; fetid discharge and deafness, 
 Bov. ; eruption and discharge, Sul. ; dull hearing, Bov., and suppuration, 
 Am. car., Bov. ; heat. Nit. ac. ; inflammation, Nitr. ; sensation like the jump- 
 ing of fleas, Zn. ; pimples on ear, Berb. ; pulling of ear, Pul., or like a worm, 
 Rhodo. ; roaring, Sep. ; swelling and discharge, Tel. ; swelling of lobe, and 
 offensive discharge, Tel.; warmth, Berb.; much earwax, Sed. (1.) ; in forenoon, 
 Cyc, Mur. ac, Sep. ; running of wax, Am. m. ; accumulation of white wax, 
 Sep. ; itching of cheek, Elap. ; irritation and red, bleeding blotches in throat, 
 Fl. ac. ; followed by humming, Na. m. ; sore pain, Arg. ; biting, Caus. (1.), 
 Berb., Verat. ; crawling, Verat. ; boring, Lau., Mil. ; crawling. Mil., Ton. ; 
 burning, Aga. m., Berb., Gale c. Gale ostr., Gom. (r.); corroding, arg.; 
 crawling., Plat. ; crawling. Alum., Ambra, Ain. car.. Ant. cr.. Bar. c. Gale 
 ostr.. Garb, v., Gaus., Goc c, Golch., Dro., Lachn., Lau., Merc, Mil., Nx. v., 
 Phe., Plat., Rhe., Rhodo., Rhu. t., Sam., Sep., Spig., Sul., Ton.; after dinner, 
 > boring in with finger, Phe.; crawling and creeping, Nx. v. ; crawling and 
 tickling, Mang. ; as if something alive were in ear, Rhu. t. ; painful crawling, 
 Am. car.. Bar. c. Gale ostr., Sul. ; as after sleep, Lau.; daily, Sep. ; deep- 
 seated. Cap.., Golch. ; in left ear, followed by yawning, later itching in right 
 ear. Rum. c ; crawling. Garb, v., Gaus., Petrol. ; tickling, Mang., Pul. ; extend- 
 ing from ear to ear, under chin, Lepi. ; to neck, Goc. c ; fine, Pul. ; hot, 
 tickling, Lach. ; intolerable, Coc. c, Fl. ac. ; painful, Pso. ; forcing 
 scratching, Mos. ; till bloody, Arg. ; sticking, Berb., Lach., Pho. ac, 
 Spig. ; fine, Berb., Lau. : tearing, Rhe. ; tickling. Aeon., Aga. m., Am- 
 bra, Am. m., Ars., Bov., Gale ostr., Ghel., Grot, c, O//., K. ca., Lyc, Mag. 
 c, Mag. m., Mang., Na. c, Petrol., Rhodo., Rut., Sam., Zn., > scratching, 
 Bro. ; pleasant, Pul.; violent, A7'g., Gale, ostr.. Garb, v., Gon., Nitr., F/w., 
 Sep., Sul., Ton. ; voluptuous, tickling, Ars., Rum. c 
 
 Jerking. See Twitching. 
 
 Jumping of fleas, sensation of. Mos. (1.), Spig. ; on putting finger in, Zn. (1.) ; 
 with itching, Zn. ; with waving, Mos.; jumping as from swashing of water, 
 when stepping suddenly, Spig. 
 
 Laceration. See Tearing. 
 
EAR: GENERAL. — LEAF. — PAIN. 1 99 
 
 Leaf lay in front of the ear, feeling as if, without affecting the hearing. K. iod. 
 
 Living were in, sensation as if something. Rhu. t. 
 
 Lump in, dream that there is a. Cinnb. (r.). 
 
 Membrane before, sensation of. Cannab. s., Verat. ; > shaking head, and 
 boring finger into ear, Sel. 
 
 Mist before, sensation of. Par. 
 
 Numbness. Calc. i.. Mane, Thu. (1.), Verb. (1.). 
 
 OBSTRUcnoN. See Stopped Sensation. 
 
 Pain. Aeon. (1.), (r.), ^Es. h., ^Eth., Aga. m., Agn., All. r.. Alum.., Ambra, 
 Am. m., Anac, Angu., Apis (r.), Ap. v., Aral., Arn., Ars., Asaf., Atro., 
 Bap., Bell., Benz. ac. (r.), Berb., Bor., Brach., Bro. (r.), Bry., Cact., Gala., 
 Calc. c. (r.), Calc. ostr., Canch., Cannab. i., Cannab. i. (1.), Cap., Carb. 
 v., Carbn. s. (1.), Case, Cham., Chel., Cina, Cinch, Cinnb., Cit. v. (r.), 
 Cle., Cob. (1.), Coch., CoLCH., Coloc, Con., Croc, Crot. t., Cup., Cur. 
 (r.), Cyc, Der. (< 1.), Dig., Dios. (1.), Dro., Uul., Ery. a., Euphm., Euphr. 
 (r.), Fl. ac. (r.), For. (1.), Gel., Grap., GuAi., H^m., Hsem. (r.), PIell., Hur. 
 (r.), Hydrs. (r.), Kalm., K. bi., K. ca., K. iod., K. n., Lach., Lach. (r.), Lepi., 
 Lil. s. (1.), Lith., Lob. s., Lyc, Mang., Ment. p., Meny , Merc, Merc. i. f, 
 (r.), Mez.. Mil. (r.), Mit., Mor. (1.), MuR. AC, Muru. (1.), Na. c. (I.), Na. m., 
 Nx. M., Nx. m. (r.), Olnd., Op., Osm., Par., Pau. p., Pau, s., Petrol., Pho., 
 Pho. ac, Phyt. (< r.), Plan., Pb., Pb. (1.), Pru. s., Pso., Pte. (r.), Pul., Pul. n.. 
 Rat. (r.), Rhe., Rum. c, Saba., Sam., Sang. (1.), Sarr., Sars., Sil., Sil. (r.), 
 Spig., Spo., Stan., Stic, Stram., Sul., Sul. ac , Tarent. (r.), Tel., Ton., 
 Verb., Vio. o., Vio. t., Wies., Zn. ; in morning. Rum. c. (r.) ; in bed, Carb. 
 v., Nx. v.; till evening, Tarent. (r.); forenoon, Sul.; 8 a.m., from cough, 
 Dios.; 9 A.M., after going out, Tel. (1.); 11 a.m., Dios. (r.); afternoon, 
 Rum. c, Sul. (r.) ; on blowing nose, Dios. (1.) ; evening. Alum., Brach. (1.), 
 Cob. (1.), Colch., Dios. (r.), Hyos. (r.), Ran. b., Sep., Sul. (r.); while sitting, 
 Lach.; i to 2 P.M., Chin. s. (r.); 3.30 P.M., Am. car.; at night, Lach., 
 Nitr., Sep.; 10 p.m., till morning, Spig.; in open air. Con.; from chewing. 
 Apis (1.), and talking, Nx. v. ; from taking COLD, > heat in hot rooms, Bell. ; 
 when cleaning, Physo., Sul.; at every stroke of a hammer. Sang, (r.); 
 from music. Tab.; from noise, Gad. (r.); putting finger in, Zn. o. ; on 
 raising his face, Nx. v.; talking and chewing, Nx. v.; from tobacco, 
 Rap.; on TOUCH, Chin. (1.); on turning eye outward. Rap.; walking, 
 Mang., Sul. ; entering warm room from cold, raw air, not the reverse, Na. 
 slfc. ; while writing, Physo.; (agg.), cold air, Bry.; lying. Bell., on painful 
 side. Bell. ; coming near the range, Coch. ; after entering a room, or being 
 in bed, Nx. v. ; stooping, Coch. ; talking, Mag. m., Mang., Nx. v. ; touch, 
 Sul.; (amel.), boring in with finger, Sul.; on rising, Carb. v.; stooping, 
 re-appearing on raising head, Cannab. s. ; warmth, Lach., or wrapping up, 
 Mur. ac. 
 
 — With the painful sensations, fulness in ears, Berb.; hard hearing, Asar., 
 and chilliness. Bell., Chain , Merc, PuL. ; lost hearing, Bry., Cyc. ; heat. 
 Petrol. ; inflammation. Bell. ; pulsation, at night, Rhu. t. ; roaring, Ars. ; 
 swelling of external ear, and headache, Pso.; tingling, Osm.; ILL- 
 HUMOR, Cham. ; headache, Berb., Ham., Nitr. ; pressing or gnawing 
 pain. Ran. s. (r.) ; pain in forehead. Sang.; pressing in forehead, Nit. 
 
200 EAR: GENERAL. — PAIN. 
 
 ac. ; pain in temples, Hyos. ; confusion, Hyos. ; stitches in correspond- 
 ing side of head, K. bi. (1.), Kalm. (r.) ; soreness of scalp, Lach. ; face- 
 ache, Lith,; pain in cheeks, Pho. ac. ; redness of cheeks, Sang.; tickling 
 on right cheek, Bro. ; drawing in joint of jaw, Na. c. ; lameness of jaw, 
 Lach.; pain in jaw, then pricking in ear, Hur. ; toothache. Plan.; 
 drawing pain in teeth, Pho. ac. Ran. s. (r.) ; gnawing pain in upper 
 teeth, K. iod. ; frequent spitting, Haem.; burning in throat, Haem.; 
 pain in stomach, K. ca. ; great nausea, Dul. ; anxiety in abdomen. 
 Aloe, GlOi ; much micturition, Thu. ; anxiety in chest, K. ca. ; 
 swelling, and painfulness to touch, of a gland in the neck, K. bi. ; pam 
 in legs, Kalm.; gnawing in hollow of knee, K. iod.; running like a 
 crawl over the same side, K. iod.; fever stage, Aeon., Apis^ Cala ^ 
 Calc. ostr.. Dig., Nx. v., Pul.^ Sul. ; cold feet, Stan., Thu. ; sweat, 
 AcoN., Bell., CoLoc, Caus., Lye, Merc, Na. m., Nit. ac, PuL, Sep., 
 Sul., Thu. 
 Pain, followed by hard hearing. Nit. ac. ; pinching, Nitr. ; stitches, Berb. 
 
 — Acute, Bell., Der., For. (1.), Plumbg. (1.), Physo. (r.), Pte. (1.), Pul., Pul. 
 
 n. (r.) ; forenoon, Fago. (r.) ; 8 a.m., on turning suddenly to right or 
 left, Erio. (r.) ; 9 p.m., Dios. (1.); all night, Merc; on chewing, Op. 
 (1.) ; inclining head, > evening holding it up. Chin. s. ; when riding in 
 cold wind. Ars. i. (< 1.); with great swelling of ear, and pain in the 
 head as if it would set him crazy, Pso.; extending inward, Tel.; 
 making him start, Sul. ac. 
 
 — Bursting, Calc. cau., Caus., Hell., Lye, Merc, Mur. ac, Nit. ac, Pul., 
 
 Sep. ; with stitches. Lye 
 
 — Cramp-like, partly, and partly sticking, and feeling as if stopped by a 
 
 swelling, Merc. sol. 
 
 — Deep-seated, Coch. (1.), Pho.; evening while walking, Lach.; with pain 
 
 in forehead. Sang. (1.). 
 
 — Drawing (including pulling). Bell., Merc; with hard hearing, Lach.; 
 
 heat, Sep. ; feeling as if moisture came out of ear. Mil. (1.) ; extending 
 from front side of head. All. c (1.) ; front of neck, Jac; within outward, 
 Sep., Sul. ac; throat, All. c (r.) ; in inner passages, Cyc (r.). 
 
 — Drawn, as if. Verb. 
 
 — Dull, Pau. p. (1.) ; causing dulness, Merc. i. f. 
 
 — Expanding (including stretching), Calc. cau.. Con., Kre., Nit. ac, 
 
 Rhodo., Spig., Til., Vio. o. 
 
 — Extending from one ear to other, on rising in bed, Ment. pi.; down- 
 
 ward, Thu.; not pressing together, but going lengthwise. Mil. (1.); to 
 forehead, Pte. (r.); lower parietal, while sitting after dinner, Indg. ; 
 to temple. For. ; after dinner, while sitting, Lidg. ; to temples and top 
 of head, Lac ac; to left orbit, Hur. (1.); out from, K. iod.; to' 
 cheek, Stram. (1.); to jaw, Spigg. (1.); lower jaw. Com.; to teeth, 
 Itu.; to THROAT, Haem.; afternoon, Fago. (r.); from neck, Thu.; to 
 lower part of neck, along course of carotid artery, < inclining head 
 to right, Lepi. ; along side of neck, Haem. (r.) ; to shoulder, Rum. c (1.). 
 
 — Hammering, Thu. 
 
 — Inflamed, as if, Merc sol. .(1.). 
 
EAR: GENERAL. — PAIN. — PINCHING. 201 
 
 Pain, Intermittent, Tarent. 
 
 — Knocking, Anac, Bar. c, Calc. ostr., Mag. m., Mur. ac, Xat., Nit. 
 
 AC, Pho., Rhu. t., Sil., Spig. 
 
 — Lancinating, Aur. s., Cad. s.. Pell., Cit. v., Cham., Crot. c, Der., Fer. 
 
 io., Gam., Hur., K. iod., Lepi., Mar., Pb., Nx. v., Rap.; in morning, 
 Tarent.; when walking or speaking, Mang. ; > foot-bath, Tarent.; 
 with or without matter. Bell., Cham., Chin.; with hard hearing. Con.; 
 sudden temporary deafness, as if something had fallen before the ear, 
 < blowing nose, Chin., Con. ; acute, on stooping, turning head, Ment. 
 pi.; extending to teeth on that side, when writing, Ment. pi. (1.); dart- 
 ing. Chin., Nx. v.; extending from root of nose, Elap. ; to shoulder, 
 Lepi. ; outward, ^th. 
 
 — Neuralgic, Iod.; in evening, Cit. v. (1., then r.) ; during gastric symp- 
 
 toms, Tarent. 
 
 — Pulsating (including throbbing), Anac, Angu., Bar. c. Bell., Berb., 
 
 Cannab. i., Caus., Cinch., Coc. c, Con., Grap., Ig., K. ca., Kre., Lye, 
 Mag. m., Merc. i. f.. Nit. ac, Pho., Rhe., Rhodo., Rhu. t., Sep. ; at 
 night, Rhu. t. ; as from an abscess. Gam.; suppurative, < boring in, 
 Anac. 
 
 — Pulling, see Drawing. 
 
 — Rheumatic, Merc. i. r. (1.). 
 
 — Shifting from ear to orbit, Hur. (1.). 
 
 — Spasmodic, Cioc (r.) ; as if it would be pressed asunder, Spig. (r.). 
 
 — Stretching, see Expanding. 
 
 — Sudden, when walking in open air in afternoon, Chin. s. (1.). 
 
 — Threads, about length of finger, from deep in the head, like, remaining 
 
 in single spots about size of a pea or hazel-nut, All. c 
 
 — Twitching, Am. car.. Am. m., Anac, Angu., Bar. c. Bell., Calc. a., 
 
 Calc. ostr., Cannab. i., Carb. v., Cina, Cle., Con., Dig., Dro., Fl. ac. 
 Hep., Lye, Mang., Merc, Mur. ac, Nat. m., Nice, Nit. ac, Nx. v., 
 Petrol., Pho., Pho. ac, Plat., PuL., Rhodo., Sars., Sil., Spig., Spo., Sul. 
 ac. Tab., Val. ; acute, Rhodo. (r.) ; extending from teeth, Pul. 
 
 — Tugging, Chin. 
 
 — Ulcerative, Anac, Cap., Caus., Cic v., Fer., Grap., K. ca., Mag. c, 
 
 Maiig., Mur. ac, Pso. (1.), Sars., Sep., Spo.; on biting teeth together, 
 A)tac. ; deep-seated, in morning, Sars. (1.) ; < boring into ear, Mur. 
 ac (1.). 
 
 — Wounded, as if, Anac, Caus., Lye, Mag. m., Mar., Sep., Spo. 
 Paraphlegia. Merc (1.). 
 
 Piercing. Calc. c, Canch., Glo. (r.) ; < cough. Nit. ac ; outward, K. ca. 
 
 Pimples, with itching. Berb. 
 
 Pinching. Agn., Am. car., Anac, Ars., Asar., Bell., Ery., Carb. a. (1.), 
 Carb. v., Caus., Colch., Coloc, Con., Crot. t., Der., Dro., Dul., Euphm., 
 Gran., Guai., Iod., K. ca., Kre., Lau., Lye, Mang., Mar., Meny., Merc, Mez., 
 Mur. ac, Na. m.. Nit. ac, Nitr., Nx. m., Nx. v., Pho., Plat., Ran. s., Rhe., 
 Rhodo., Rhu. t., Saba., Sabi., Sep., Spig., Stan., Stap. (1.), Sul., Thu. (r.) ; in 
 morning, Na. c (r.) ; afternoon, Aran. d. (r., then 1.) ; night, Bry. ; after 
 hiccough, Bell, (r., then 1.) ; with aching, Nx. v. ; cracking, Na. e ; stitches, 
 
202 EAR: GENERAL. — PINCHING. — PULSATION. 
 
 Sam. ; stitches behind the ear with decrease of the pain, Nitr. (1.) ; drawing 
 pain in articulation of jaw, Na. c. ; deep-seated, Fer. ma., Mur. ac. (r.), 
 Sabi. ; jerking pinching, Mur. ac. (1.); extending inward, DuL; outward, 
 Carb. v., Rhodo. ; itching, Rhe. ; pressing out, Caus. 
 
 Piston working up and down, sensation of. Ami. n. 
 
 Plugged Sensation, See Stopped Sensation. 
 
 Pressure. Aeon., Aconin., Anac, Arn. (]., then r.), Asaf. (1.), Bell.^ Berb., 
 Calc. c, Calc. ostr., Calc. ph., Cannab., Carb. v., Carl., Coc. c, Crot. t., 
 Eupi. (r.), Fl. ac. (r.), Glo., Hell., Indg., Ip., Kis. (Lach.), Lau., Lye, Merc, 
 i.r., Mur. ac, Na. c, Na. slfc. (r.). Nit. ac, Nx. m., Nx. v., Olnd., Petrol., Pho., 
 Rhe., Rut., Saba., Sars., Sep., Sil., Spig., Spo., Tarax., Tel., Thu., Verat. ; in 
 MORNING, Verat. (r.); when waking, Sep. (1.); 6 a.m., after getting out of 
 bed. Rum. c (r.) ; evening. Hype, (r.), K. bi. ; when chewing, Seneg. (r.); 
 from pustule. Gas. (1.); in warm room, Pho.; (agg.), 9 a.m., Na. slfc; 
 cough, Nx. v.; motion of lower jaw, Na. m. (1.); (amel.), in cold, Pho.; 
 WITH heat in head, Jat. ; fever-stage, Asar. ; acute, Rut. ; on going into 
 open air, Mang. (r.) ; asunder, Cannab., Con., Grap., Hell., Nit. ac. Par., 
 Pul, Rhodo. (1.), Spig., Spo.; bubbling pressing asunder, K. n.; deep- 
 seated, Mang. o. (1.) ; on which he was lying, Bar. c. (r., then 1.) ; > stirring 
 finger in, Fl. ac. (1.) ; dull, Chel. ; as from a finger. Aeon. (1.), Rhe. ; hot, 
 < inserting finger, Rut.; internal, Tarax. (1.); with tension, Calc cau. ; 
 as if every thing would be pressed together, almost cramp-like, Dro. (r.) ; 
 INWARD, Sep. ; alternating with a sensation as if torn out, alternately with 
 orbits. Bell. ; from opposite sides, K. n. ; outward, Berb., Caus., Chel. 
 (r.), Guare., Ir. v., K. n., Merc, Mur. ac. Par., Pru. s., Pul., Sep.; from 
 10.30 A.M., Hydrs. ; while straining at stool, Sep. ; with cough, Nx. v. ; rhyth- 
 mical, Mur. ac. (r.) ; as if something must be torn from within, Lil. t. ; fol- 
 lowed by tickling, Chel. (r.) ; as from a peg or plug, Anac, Cannab. s., Nx. 
 m., Olnd., Par., Spig., Spig. (1.) ; as from a dull point, Hydrphb ; scraping. 
 Rut.; stitching, evening, Berb. (r.); sudden, acute. Con.; tensivf:. Dig. 
 (1.); as if something were pressing through, Calc. ostr.; tickling, < 
 inserting finger, Rut, 
 
 Pricking. See Stitches. 
 
 Prickling, Dul. ; itching, Spig. (r.). 
 
 Puffing, from pulsation of temporal arteries. Benz. ac. 
 
 Pulling. See Drawing. 
 
 Pulsation (including Beating and Throbbing). Aloe, Alum., Ami. n., 
 Am. m.. Bell., Bell, (r.), Berb. (1.), Bon., Bro., Cact., Cala. (r.), Calc. r., Calc 
 ostr., Calc. ph., Cannab. l, Cannab. s., Carb. ac, Carbn. o. (1.), Carb. v., 
 Caus., Chel., Chin., Coloc (< 1. ), Con., Dig., Gam. (1.), Glo. (r.), Grap., 
 Hydro, (r.), (Ig.), K. ca., K. n.. Lye, Mag. m. (r.), Merc. c. (< 1.), Mur. ac, 
 Na. c (1.), Na. m., Ol. an.. Op., Pho., Plan. (1.), Pte. (r.), Rhe., Rhodo. (1.), 
 Sel. (r.), Sep., Sil. (r.), Spig. (1.), Sul., Tel., Zn. ; forenoon. Coca; even- 
 ing, Cob. (1.), Ind., Physo. ; on falling asleep, Sil.; in bed, Thu.; night, 
 Dig. (< 1.), Am. m. (r.) ; when lying on ear. Am. car. (1.), Bar. c, K. ca. (r.), 
 Sil. ; in open air. Aeon. (1.) ; ascending steps, Gas. ; after breakfast, Zn. ; 
 during internal coldness, Amyg. ; after dinner, Carb. a. ; on lying on 
 left side, Bar. c. (1.); when sitting, Am. m. (r.) ; on stooping, Rhe.; 
 
EAR : GENERAL. — PULSA TION. — SXAPFING. 203 
 
 after walking, Pho. ; while writing, Rhe., Zn. ; (agg.) by exposure to air, 
 Pte. (r.) ; eating, Grap. ; (amel.), by pressure, Carb. a. ; stooping, Grap.; 
 turning over, Am. car. (1.); WITH cold sensation in ear, Eerb. ; creaking 
 when lying on affected ear, and with pimples and pustules in external ear, 
 Spo. ; discharge, Tel.; dryness, Berb. ; hard hearing, Hep, ; otalgia, at night, 
 Rhu. t. ; rushing, Coloc. ; ACUTE, deep, extending outward, Merc. i. f. (1.) ; 
 ALTERNATING with singing, Caus. ; after ringing and tearing. Plat. ; as if they 
 would BURST outward, Cact. ; deep-seated, when lying on ear. Bar. c. (r., 
 thenl.); extending inward, Berb.; heavy. Rum. c. ; preventing sleep, 
 Cact. (r.) ; rhythmical, lying on, Coc. c. ; shaking eyes, Sil.; slower 
 than pulse, morning after waking, Grap. ; synchronous with pulse, Coc. c. 
 (1.), Rum. c. ; wave-like, > holding hand over eyes, Spig. ; two pulsations, 
 then heat rushing out, Ol. an. 
 
 Railroad-train going through brain, sensation of, > alternate days, Chin. s. 
 
 Rawness. 2.30 p.m., Ol. an. 
 
 Roaring would occur, sensation as if. Mez. 
 
 Rolling back and forth, it seems as if something were, on shaking head. 
 Rut. 
 
 Roughness. Aeon. 1., Rhu. v. 
 
 Scraping. Lye. ; as from an ear of corn, Pb. ; as from a feather, 01. an. ; as 
 from the turning of a blunt stick. Rut. 
 
 Scratching. Pb. (r.), Pho. ac. Rut.; like a bristle, Pb. 
 
 Screwing, extending to shoulder, morning on waking, Daph. ; twisting, even- 
 ing, Nx. V. 
 
 Sensation in inner passages lost. Mur. ac. 
 
 Sensitiveness, and of adjoining parts, with otitis, Merc. ; to draught, wind, 
 etc., Cham., Lach. ; to touch, with discharge, Carb. v., Cham. ; to touch, 
 with otitis, Mag. c. 
 
 Shocks. Anac, Bell., Calc. ph. (1.), Con., Na. m., Na. m. (1.), Xx. v., Spig. ; 
 with contractions. Bell. ; followed by ringing, Na. m. ; as of distant 
 artillery, Bad. ; electric, Cannab. i. 
 
 Shooting, Apoc. c. Arum d.. For. (L), lod. (r.), Phyt., Plan., Sep. (r. ), Sil. 
 (1.), Stram., Trom. (r.) ; afternoon, Xa. ar. (r.), Trom. ; 3 p.m., Physo. 
 (1.), Trom. (r.) ; 3.30 P.M., Trom. (r.) ; 6.45 P.M., Physo. ; 10 p.m.. For. (1.) ; 
 after breakfast, Arum d. (r.) ; when lying on right side, Pte. (r.) ; 
 when sneezing, Calc. c. ; < descending stairs, lod. (r.) ; with aching. 
 Lob. i. (r.) ; deafness, Bell. ; as if abscesses were forming, < walking, Ment. 
 pi. (< 1.) ; acute, making him cry out, X'x. v. : deep-seated, Fer. ma. ; 
 EXTENDING to chin. Bell.; inward, .^th., Alum., Am. m., Arn., Berb., Carb. 
 v., Dro., DuL, Grap., Hyos., K. bi., K. iod., ^^ag. c, Meny., X'a. c, X'a. s., 
 X'x. v., Pho., Rhu. t., Stro., Tarax., Ton. ; outward, ^th.. Alum., Am. m., 
 Ars., Cannab. s., Dul., Glo., Gran., K. ca., Lau., X^icc, Rhodo., Sep., Spo., 
 Stro., Tarax., Vio. o. ; to spine, Pte. (1.) ; to temporal region, Eupi. (1.) ; up- 
 ward, Lil. s. ; obtuse, Cact., Mang., Meny., Xa. m., X'itr., Plat., Sars. ; 
 sticking, ^th. (1.) ; SUDDEN, Pho. ; TEARING, Tep. 
 
 Smarting. Bor., Cannab. s., Caus., Cic. v., Lach., Lye, 01. an., Sep., Spo. ; 
 corroding, Arg., Dro., Plat. ; itching, Lye. 
 
 Snapping. Lac. ac, Tarent. (r.) ; morning, on rising, when chewing, Aq. p. 
 (r.) ; on opening mouth, Dul. (1.) ; as of electric spark, Ambra. 
 
204 EAR: GENERAL. — SOMETHING BEFORE. — STITCHES. 
 
 Something before, sensation of. Aeon., Alum., Angu., Bry. (1.), Cala., 
 Card, b.. Chin., Cocc. (r.), Cyc. (r.), K. iod., Merl. (1.), Pko., Sid. (1.) ; dur- 
 ing MENSES, > boring with finger, Mag. m. ; on blowing nose, Con. ; inter- 
 mittent, Pho. (r.). 
 
 Soreness. Bry. (r.), Calc. ph., Jug. r., Mag. s. (1.), Mos., Pte. (r.), Sep., Sul. 
 (r.) ; evening, after removing earwax, when walking, Bor. (1.) ; on boring 
 in with finger, Bor.; after itching, Arg. ; on touch, Act., Ery. a. (1.), Mag. c. 
 (1.), Mag. V. (r.), Merc. i. f., Spo. (r.), Zn. a. (1.) ; as if beaten, Arn., Cham., 
 Cic. v., Cina, Crot. h., Ru T. ; burning, Pho. ; extending from throat, Lith. : 
 down neck. Bap. 
 
 Spasmodic sensation in and around the ears. Ran. b. 
 
 Squeezing. Arn., Bell., Carb. a., Chel., Dro., Grap., K. ca., Rut., Sars., 
 Spig., Thu., Zn.; sensation as if something were squeezed out, Thu. 
 
 Starting. Benz. ac. ; jerking, with otitis, Nitr. 
 
 Stitches (including Pricking and Stinging. Compare with Tearing). 
 ^th. (r.), Aga. m. (1.), Aloe (1., then r.), Alum., Am. car. (r.), Aur. m. n.. Bar. 
 c. (1.), Bart., Bell., Berb. (r.), Bor. (1.), Bro. (r.), Bry., Cala., Camph , Calc. c. 
 (1.), Calc. ostr., Carb. a., Cham., Chel.. Coc. c. (1.), Colch. (1.), Cob. (1.), Con., 
 Cup., Dro. (r.), Dul., Euphr., Fer. p. (r.), Fl. ac, For., Gam., Glo. (r.), Hip. 
 (1.), Hur., Ig., Iod., Indg., Jat., Jat. (1.), Kalm., K. bi., K. bi. (1.), K. ca., K. 
 n.. Kin. (r.), Kre., Lach., Lact., Lepi., Lepi. (r.), Lau., Lip., Lye, Mag. m. 
 (r.), Mag. r. (1.), Meny. (r., then 1.), Merc. c. (1.), Merc. i. f. (1.), Mil. (1.), Mur. 
 ac, Nil. c, Na. m., Na. slfc. (r.), Nice (1.), Nit. d. s.. Nit. ac, Nit. ac. (r.), 
 Nx. m., 01. an., Pb., Petrol., Phe., Pho. ac, Pho., Plat., Pie., Pso. (1.), Pul. 
 (1.), Ran. b. (1.), Rap. (r.), Rhu. v.. Rut. (r.), Saba. (1.), Sam. (r.), Sarr., Sep., 
 Sep. (1.), Sil., Spig., Stap., Sul. (1.), Tab., Tarent. (r.), Thu., Til., Verat. (1.), 
 Vesp. (r.), Wild, (r ), Zn. (r.) ; morning. All. c (r.), Ars., Fer. (r.). For., 
 Nx. v.; when washing in cold water, Bor.; forenoon, Chin. s. (1.), K. bi. 
 (r.), Mag. c (1.), Na. m., Nx. m., Pie., Sarr. (r.) ; lo a.m., Ir. f., Mag. s. ; 
 NOON, Ammc. (r.), Chin. s. (r.), Pso.; afternoon, Bry. (1.), Caibn. s. (r.), 
 For. (1.), Merc c (1.), Pie.; evening, Aq. m. (r.), Berb., Bor. (1.), Chin. s. 
 (r.), Grap. (1.), Hype, (r.), June, K. ca., Merc, Ox. ac. Ran. b. (1.), Stap. 
 (r.), Tarent. ; in bed, K. iod., Thu.; after eating, Grap. (1.); i P.aM., Grap. 
 (1.); 4 P.M., Kalm., Na. c. (r.) ; 5 P.M., Berb. (r.) ; 8 p.m., Na.slfc (r.) ; 8 to 
 10 p.m., Phel. ; 9 p.m., Carbn. s. (1.) ; night. Alum, (r.). Cop. (1.), Kalm. (r.), 
 Pho.-, when awaking, Carbn. s. (1.); during toothache. Hell, (r.) ; when 
 going to BED, Fer. p. (r.) ; during stroke of bell, Pho. ac, Mag. m. (1.) ; 
 after cramp in ears, Thu. ; after dinner, Carbn. s. (r.), Zn. ; from draught 
 OF AIR, Camph.; while eating. Verb. (1.) ; when pressing forehead. Nit. 
 ac. ; when moving JAW, Pho. ac. ; during her own singing, Pho. ac. ; while 
 standing, Mag. s. (1.); when stooping, Merc, sol.; when turning head. 
 Chin. S. (r.) ; when walking, Ammc. (r.), Bor. (1.) ; (agg.), evening, Na. 
 m.; open air. Tab. ; stooping, Lepi. (r.) ; (amel.), putting finger into ear, 
 Pho. ac. ; rubbing, Ol. an. 
 
 — With stitches around ear. Con., Vio. ; stitches behind. Am. car.. Bell., 
 Kalm. (r.) ; boring inward, Mag. c; feeling as if closed, Glo.; hard 
 hearing. Am. m. ; inflammation. Alum. (1.), Merc, Merc, c ; sensation 
 as if too narrow, Lye ; pain as if it would burst, Lye ; pinching, Sam. ; 
 
EAR: GENERAL. — STITCHES. — STOPPED. 205 
 
 roaring, Caus., Nit. ac. ; musical sounds, Pho. ac. ; swelling, Kre. ; 
 tearing, Cham., Pb. ; tearing in ear, catarrh of Eustachian tube, redness 
 and swelling of meatus, Pul. ; boring tearing. Hip. (1.) ; excitement and 
 delirium, Stram. ; weeping and weakness, Sil.; loud lamenting, Sep.; 
 crying out, Nx. v. ; HEADACHE, < at night, Cyc. ; headache, and stitches 
 in parotid gland, K. bi. (1.) ; pain in face, Pho. ac. ; pain in jugular 
 (zygomatic bone), Bro. ; diphtheria, K. bi. ; cough, Nit. ac. ; with 
 FEVER stage, Calc, Grap., Pul.; beginning of chilliness. Gam. ; sudden 
 general sweat, Caus. 
 Stitches, followed by hard hearing. Cap.; straining in ears, Lact. (1.) ; 
 pain in arms, Kalm. 
 
 — Acute, Cocc. (1.), Na. c. ; piercing deep, Bry. ; making him start, Mag. 
 
 m., Ton. 
 
 — Alternately in each, on entering open air or house, Bry. 
 
 — Awl, as with an, Mag. m (1.). 
 
 — Boring, Caus. (r.). 
 
 — Burning, itching, Tarax. (r.). 
 
 — Burrowing, Na. m. 
 
 — Deep-seated, Jat. (1.). 
 
 — Digging, Berb. (r.). 
 
 — Drawing, Berb. (r.). 
 
 — Dull, Nice, Thu. (r.). 
 
 — Extending from palate. Cob. (1.) ; to drum, Dul. (1.); to eye, with a 
 
 sensation of a wind streaming into ears, Pul.; to head, Bry,; inward. 
 Am. m., Arg., Arn., Carb. v., Dro. (1.), Nx. v., < on coming from cold 
 air into warmth, not the reverse, Na. slfc. (r.) ; in and out, K. ca. ; to 
 lobule, Pho.; to nose, Sil.; outward, Alum., Am. ??i., Calc. c, 
 Cannab. s., Con., K. ca., Lau., Mang., Aui. c, Sil., Stro., Tarax., Vio. o., 
 Zn. ; to parietal bone, Ran. b. (r.) ; to temple, Indf. ; to head, with 
 red, rough tetter in front of ear, and oozing and bad smell behind ear, 
 Olnd. (1.). 
 
 — Fine, Berb. (1.), Colch., Ox. ac. (1.), Pb. (r.) ; with itchmg, Berb. 
 
 — Hot were streaming from, as if something, yEth. (< r.). 
 
 — Intermitting, Benz. ac. (r.). 
 
 — Large, shooting, with fretfulness and vexation about trifles, Cham. 
 
 — Pressing, F1. ac. (r.). 
 
 — Pulsating outward, Glo. (r.). 
 
 — Nail, as from a, while sitting, Berb. (r.). 
 
 — Rheumatic, Lye. (r.). 
 
 — Slow, Sang. (1.) ; broad, extending inward, Dro. (1.). 
 
 — Sudden, extending into sternum and left side of neck, Cocc. 
 
 — Tearing, Lye, Nx. v. ; with external swelling, especially in children, Zn. 
 
 — Twinging, Colch. (1.). 
 
 — Twitching, Aga. m. (r.). 
 
 Stopped sensation (including Obstruction and Plugged sensation). 
 Aeon. (1.), iEth. «1.), Aga m. (1.), Anac. (1.), Angu., Arg. (r.), Arg. n. (1.), 
 Asar., Ath., Aur. m. (1.), Berb. (1.), Bor., Bry., Carb. v., Caus. (r.), Cham., 
 Chel., Chin, s., Chlf., Cnmb., Coc. c. (1.), Cod., Colch. (r.), Con., Conin., 
 
206 EAR : GENERAL. — STOPPED. — TEARING. 
 
 . Crot. h. (r.), Cyc. (r.), Dig., Dios., Gas., Glo., Grap., Guare., Hur., Hydrc. 
 (L), Hydrs. (1.), Indg., K. bi. (1.), K. ca., Led., Lepi., Lye, Merc, c, Merc. 
 SOL., Mez., Mil., Na. c. (1.), Na. m.. Nit. ac, Ol. an., Op., Pho., Physo., Pie., 
 PUL., Rap., Rhu. t. (r.), Run. c. (1.), Saba., Sec. c, Sel., Seneg., Sep., Sil., 
 Spig. (1.), Sul., Tab., Tel. (r.), Tep., Thu., Til. (r.), Upas, Verb. (1., then r.) ; 
 MORNING, Ant. cr., Caus., Thu. (r.) ; on rising, Sil.; forenoon, Tel.; 
 AFTERNOON, Mil., Na. m. ; evening. Ant. cr. (r.),,Ham. (r.), Thu. (r.) ; in 
 bed, Sel. ; 3 r.M., Jac. ; 8 P.M., Dios. ; 10 p.m., Tel. (< 1.) ; after dinner. 
 Mil. ; after lying on it, Sel. (1.) ; on reading aloud, Verb. ; after stitches 
 in glands, Berb. ; while TALKING, Meny. ; on WALKING, Colch. ; (agg.), ex- 
 citement. Dig. ; lying on ear, Coc. c. (1.) ; (amel.), after breakfast. Ant. cr. ; 
 afternoon, yawning, Na. m. ; inserting finger, Sel. (1.) ; WITH drawing, Lach. ; 
 good hearing, Mez. ; heaviness in and before ears, Garb. v. ; roaring, Grap., 
 Hell., Merc, c, Seneg., Sep. ; before ears, Coloc. (1.) ; deep-seated, in 
 evening, Lim. (r.) ; as from grease, and again opening, Bov. ; hissing 
 throbbing, Coc. c, Hep., K. ca., Nx. v., Ol. an.. Petrol., Pul., Saba., Sul., 
 Thu. 
 
 Straining after stitches, Lact. (1.) ; with tearing m alternating jerks, Mez. 
 
 Stuffed sensation, ^th. (r.), Cannab. i. (r.), Carbn. s., Cot. (r.), Nico., Sul. ; 
 forenoon, Pso. 
 
 Swarming (of animals), sensation < lying still. Ant. cr. 
 
 Swelling. Ant. cr. (1.), Apis., Ars., Gale. c. (r.), Gale, ph., Cannab. s. (r.); 
 Caus., Chlol., Cist., Crot. c. (r.), Ery. a. (1.), Glo. (r.), Grap. (1.), K. ca., Pho. 
 ac. Jug. (r.), Med., Nit. ac, Pic ac, Pte. (r.), Rhu. t. (1.), Rhu. v., Tel. (1.), 
 Ust. u., Zn. ac. (1.) ; with discharge, Caus., Cist. ; itching and discharge, 
 Tel. ; inflammation, Kre., Nitr. ; stitches, Kre. ; extending half way up 
 cheek. Cist.; over parotid gland to Zygoma, Bry. ; hot, Bor. ; inflamma- 
 tory, Bell., Bor. 
 
 Suppuration. Caus., Hep., Lye, Merc, Sec. c ; with itching and hard 
 hearing, Am. car., Bov.; sensation of, on touch, Coc. c (I.). 
 
 Tearing (including Laceration. Compare with Stitches). Aeon. (1.), .^th. 
 (r.), Aga. m. (r.), Ambra (r.), Am. m. (r.), Arg. n. (r.), Arn., Arum t., Bov. 
 (r.), Cad. s.. Gale c (1.), Calc ph., Camph. (1.), Cannab. i. (r.), Canth. (r.), 
 Garb. a. (1.), Garb. v. (r.), Caus. (1.), Cham., Chel. (1.), Con. (r.). Cup. (r.), 
 Cyc, Guai. (1.), K. bi , K. ca., K. iod., Lach., Lachn., Lau., Lye (r.)^ Mag, 
 m. (r.), Mep., Merc, Merc. sol. (r.), (1.), Merl. (r.), (1.), Mur. ac (r.), (1.). 
 Na. c, Nice (r.), Ol. an., Par., Pb. (r.), (1.), Petrol., Pho., Plat., Rat., Rat. (r.), 
 Rhodo. (r.), Sabi. (1.), Sil., (Squ.), Stram. (r.), Stro. (r.), Sul. (1.), Tab. (r.), 
 Tarent. (r.). Til., Ton. (1.), Verb, (r.), Zn. ; morning. Ant. t. (r.), Mang. (r.), 
 Sars. (r.); in bed, Cart, v.; forenoon, Mag. c (1 ) ; while sitting, Pho.; 9 
 a.m., Elap. (1.); afternoon, Bov. (1.); about NOON, Sul. (1.); EVENING, 
 Alum., Indg., Ton. (r.) ; in bed, Thu. ; 7 p.m.. Zing, (r.) ; after dinner. Garb, 
 a., Phe. ; inclining body to right, Mag. m. (1.); (agg.), cough, Pul.; 
 (amel.), pressure of hand, Alum., Garb. a. ; with sensation as if a cool 
 breeze blew against it, Stram. ; crawling, Zn. ; creeping, Sul. ac. Ton. ; dis- 
 charge, after measles, Colch. ; inflammation, Merc. ; itching, Rhe. ; stitches, 
 Cham., Con., Pb. ; tearing in ear, catarrh of Eustachian tube, redness and 
 swelling in meatus, Pul. ; straining, in alternating jerks, Mez. ; twitching, 
 
EAR : GENERAL. — TEARING. — TWIA^GING. 20/ 
 
 roaring and ringing, from one's own singing, Pul. ; followed by discharge, 
 K. ca. ; ALTERNATELY in each, Aph., Chen. ; BORING, <v'ith stitches. Hip. (].) ; 
 DARTING, Pul.; DEEP-SEATED, Gam., Mez. (1.), Pb. (r.), Sul. ac. (1.), Ton. 
 (1.) ; evening, Merl. (1.) ; during menses, Merc. sol. (1.) ; on rising from 
 stooping. Ant. t. (r.), Mang. (r.) ; extending into parietal bone, forenoon, 
 Indg. ; DRAWING, Aph., Coc. c. (1.), Merl. (1.), Zing, (r.) ; extending from 
 face. Mil.; backward. Bell.; inward, K. ca., Lau., Nx. v.. Ton., Verb. (1.) ; 
 outward. Bar. c. (1.), Dul., Til. (r.) ; into external cartilage, K. ca. ; to 
 cheek, Anac. (1.) ; into head, Sul. (1.) ; to jaw, Merl. (1.) ; through occiput, 
 Ambra; to teeth, Ol. an.; in afternoon, Chel. (r.) ; to temples, Eupi. (r.), 
 Lach. ; fine, Grat. (1.) ; intermitting, 8 a.m., while standing, Na. c. (r.) ; 
 hiternally, Cyc. (1.) ; INTERMITTING, 8 A.M., while sitting, Na. c. (r.) ; ITCH- 
 ING, Caus. ; RHEUMATIC as if broken, Mez. (1.) ; sticking, K. bi.. Mar. (1.) ; 
 forenoon, while standing, Pb. (r.) ; afternoon, i^th. (r.) ; as if in bone. Rap. 
 (1.) ; extending outward, Gran. (1.) ; THRUSTING, Spig. (r.) ; TWITCHING, 
 Mag. m. (1.), Mez. (1.), Pul., Tab. (r.) ; as if being torn out, Bell., Cannab. 
 i., Bry. a.. Par., Sap. (1.) ; and at the same time in bone above and beneath 
 patella, K. ca. ; alternating with orbits, as if alternately torn out and pressed 
 in, Bell. 
 
 Tension. Alum., Am. car., Asar., Aur., Bov., Gale, cau., Calc. cau. (1.), 
 Carl., Coc. c, Colch., Con., Dig., Dro., Euph. p., Euphr. (1.), Glo., Kre., 
 Lact., Lachn., Lye, Ment. pi. (< r.), Mez., Nitr., Nx. v., Pb. (r.), Spo., Stap., 
 Thu., Verat., Vio. o. ; morning and afternoon, Hydrs. (r.) ; when brush- 
 ing hair on occiput, Ars. s. f. (r.) ; WITH want of ease, Caus. ; changing 
 from temples, waking from sleep, < morning, Glo. ; internally, with 
 pressure, Calc. cau. 
 
 Thread drawn through, sensation of. Rhu. t. 
 
 Throbbing. See Pulsation. 
 
 Tickling. Aeon, (r.), Aga. m. (r.), Ambra, Am. m. (r.), Ars., Bor. (1.), 
 Bro., Canth. (1.), Carbn. s , Chel. (r.). Chin., K. ca., K. iod., K. n., Lach., 
 Mag. m. (r.),Mang., Mur. ac. (1.), Na. c, Petrol., Saba., Sang., Sul., Sul. ac. 
 Tab., Til. (r.). Ton. (1.), Zn. (1.); eve.ving. Gala, (r.). Pie.; 6.30 p.m., Mag. 
 c. (r.) ; ID p.m., from sound of voices. Rum. c. ; after dinner, Phe. ; after 
 painful pressing out, Chel. (r.) ; (amel.) boring in with finger, Mag. m. ; 
 after eating. Aeon. ; with pleasant warmth, Mag. m. ; followed by stiff- 
 ness of jaw. Petrol. ; crawling, after dinner, Lau. ; with ringing. Cinch. ; 
 as from earwax, Crot. h. ; as from a veil over, Pho. 
 
 Tingling. Anac. (r.), Bell., Brach., Cent., Chin, s., Fer. ma., Lachn., Lol. 
 Osm. (r.). Sain, (r.), Sep., Sul., Sul. i., Thu. (I.) ; noon, Stry. ; > boring in 
 with finger, Lachn.; WITH pain, Osm.; tremulous, Pul. 
 
 THRuyrs, Acute. Nx. v.; forenoon. Gen. (1.); dull, back and forth, Nx. 
 m. ; coming from both sides, as if two plugs were penetrating to meet ni 
 centre, Anac. 
 
 Thumping, afternoon on entering room from open air. Thu. ; < lying on 
 either side, Na. h. 
 
 Trembling on rising. K. ca. ; after hearing bad news, Saba. ; as from rush 
 of blood to head. Petrol. 
 
 Twinging. Aloe, Anag. (r.), Arg. n.. Bar. c, Garb. v. (1.), Caus., Coloc. (r.), 
 
208 EAR: GENERAL. — TWITCHING. — WORMS. 
 
 Crot. t. (1.), Dul. (r.), K. n., Merc, sol., Mez. (< r.), Par., Pru. s. (1.), Stap. 
 (1.) ; AFTERNOON, Aran. d. (r., then 1.) ; evening. Aloe, Carb. v. (r.) ; acute, 
 morning before rising, Fer. (r.) ; drawing, Coc. c. (1.) ; extending out- 
 ward, Carb. v.; spasmodic, deep in, Crot. t. (1.). 
 
 Twitching (including Jerking), ^th.. Am. car. (1.), Bar. ac. (1.), Bar. c. 
 (1.), Bov. (1.), Calc. c. (r.), Calc. p., Cannab. i., Cast. eq. (1.), Hep., K. ca., 
 Mag. m. (r.). Mane, Op., Petrol., Pho., Piil , Sil. (1.), Sul. ac. (r.), Thu. (r.) ; 
 morning, Ant. t. (r.), Mang. (r.) ; on waking, Nx. v. ; evening, Nx. v. ; on 
 RISING, K. ca. ; with cold sensation. Plat. ; external heat, Pul. ; tearing, 
 roaring and ringing, from one's own singing, Pul. ; drawing, Cle. ; extene 
 ING inward, Pho.; to eye and lower jaw, Spig. ; to lower jaw, Nit. ac. (r.). 
 Cans. ; as if something were twitched out with a hook, 6 a.m., Na. 
 m. (r.) ; pinching, Zn. ; quivering, extending to left corner of mouth, Thu. ; 
 sticking, Nice. ; boring dull sticking, extending into throat, Spig. ; sudden, 
 Chr. ox. (1.) ; tearing, Pul. ; thundering, like distant cannonading. Plat. 
 
 Twisting. Am. m. (1.). 
 
 Unpleasant Sensation. Feru., < evening, Physo. ; indescribable, Mos. (r.) ; 
 from noise, Merc. ; with crackling, Mos. 
 
 Valve, sensation as of a, opening and closing at each step. Grap. (r.) ; 
 leather-covered metal valve in motion, Aga. m. 
 
 Warm Feeling. Alum., K. ca., Mang., Meny., Mur. ac, Plait., Seneg., Sul. 
 ac. ; WITH fluttering, Mang. ; itching, Berb. ; redness. Plat. ; feeling as if a 
 thin skin were over it, Asar. ; pleasant, with tickling, Mag. m. 
 
 Water rushing in, sensation of. Sul. 
 
 Waving, as from rush of blood to head. Petrol. 
 
 Whirling. Lye, Merc. (1.), Nx. v. ; evening in bed, Lact. ; whirring, Caic. 
 a., Meny., Pul.; quavering^ Nx. v. 
 
 Wind in, sensation of. Bell., CheL, Eupi., Many., Mez., Mos. (1.), Pul., Rhu. t., 
 Spig., Stan. (1.), Stap., Stram., Vine. ; with tendency to bore in, Mez. ; 
 deafness, Cocc. (r.) ; hard hearing, except for speech, Ign.; hissing, Dig.; 
 pulsation, Coloc. ; sounds penetrating the whole body. Then; sound of 
 trickling water, Thu. ; cool, Stan., with tearing, Stram. 
 
 Worms in. Rut. ; sensation of, Guare., Pic. ac, Rhodo. 
 
EAR: EXTERXAL. — ASLEEP. — HEAT, 209 
 
 EXTERNAL EAR. 
 
 External Ear. Asleep Sensation, Sul. 
 
 Blisters. See Vesicles. 
 
 Blueness. Nit. ox., Sant. 
 
 Brown Spots. Cop. 
 
 Burning. Cle., Jug. r., Kre., Pic. ac, Upa. ; i a.m., Mit. (1.); evening, Ars., 
 Trom. (< r.) ; after coffee, Sul. (r.) ; after scratching, Ol. an. ; with 
 heat and redness, as if they had been frozen, Aga. m. ; stitches on pressure 
 and swelling, Nitr., Pho. ; picking stitches in middle ear, Cle.; swelling and 
 heat, Na. m. 
 
 Chilblains, affections as from, caused by cold. Bell. 
 
 Coldness. Berb. (1.), Calc. ostr., Dul., Ip., Ir. fee., A", ca.. Lack., Mang., Meny., 
 Merc, Plat., Seneg., Stap., Verat. ; feeling of. Nit. ac. ; cold feeling in, 
 Calc. ostr., Ip., Meny., Stap., Veratii. ; after heat, Berb., Lach., Merc. ; in 
 a w^\rm room, K. ca. ; with paleness, Verat. v. ; cough, Verat. ; hot stage, 
 Ip. ; alternating with heat, Verat. ; as if water got in it, Meny. ; as if 
 cold water were running out and through ear, Merc. ; like a cold WIND, 
 Caus., Mang., Plat., Stan., Stap. ; catches cold easily, Cham., Lach. 
 
 Compression. Thu. 
 
 Cracks. Mar. 
 
 Cramp. Ars., Juni., Thu. (r.) ; and in middle ear, evening, Ran. b. (1.). 
 
 Crawling. A)it. ci'., Bro., Sul. ac. ; with swelling, Spo. 
 
 Denuded. Merc. sol. (< r.). 
 
 Desquamation. Bry., Cop., Rhu. t. 
 
 Drawing. Con., Olnd., Pho. ac, Stan, (r.), Tarax., Vio. o. (1.) ; sensation as 
 if drawn out of head, Cannab. s. ; drawing-together pains and swelling, Caus. 
 
 Dryness, with hard hearing. Petrol. 
 
 Elevations. Sep. ; like wasp-stings, brownish yellow. Cop. 
 
 Eruptions. Aga. m.. Bar. c, Cic. v., Petros., Sep.; with eruptions behind 
 ear, Cinch., Cic. v., K. iod., Petrol., Pho., Pul., Sep., Sil., Spo., Sul.; swell- 
 ings, Sep. ; confluent. Cop. ; humid, and behind ear, Calc. ostr. ; itch- 
 ing, Thu. (r.). 
 
 Erysipelas, with itching, heat, redness, and blisters. Mep. 
 
 Formication. Arun. (1.). 
 
 Furuncles. Pic. ac, Pul., Spo., Sul. 
 
 Gnawing. K. ca. 
 
 Heat. Agn. (1.), Angu., Arn. (1.), Asar. (r.), Berb., Calc. p., Canna, Cap., Chin., 
 Cle., (Cocc), Cyc, Der., Grat., Hep., Kre., Meny., Mur. ac, Ped., Petrol., 
 Pho. ac, Pul., Ran. b., Spira., Sul.; evening, Bry., Tab.; after scr-\tch- 
 
210 EAR: EXTERNAL. — HERPES. — PIMPLES. 
 
 ING, 01. an. (r.) ; with heat of middle ear, Calc. p. ; partial deafness, Mur. 
 ac. ; itching and redness, Hep. ; violent itching, K. ca. ; redness, Alum., Ant. 
 or., Garb, v., Kre., Mag. c, Mep., Na. m., Nit., Peti. (1.), Pho., Pul., Sep., 
 Tab., evenings. Alum, (r., then 1.), every evening, Carb. v. (r.) ; swelling, 
 Na. m., Pho. ac, Pul., Zn. ; twitching in ear, Pul. ; anxiety and rigor, Ars ; 
 headache, Zn. ; cold stage, Aeon., Alum., Ars., Bell , Dig., Merc, Pul., Rhu. 
 t. ; cold feet, Kre. ; followed by coldness, Berb., Lach., Merc. ; alternat- 
 ing with coldness, Verat. ; burning, Arn., Cle., Kre., Nitr. ; and in middle 
 ear, Case, morning in bed, (Cocc.) (r.) ; redness, itching, and swelling, < 
 night, Ail. ; heat in back of head, Atro. ; redness of cheeks. Sang. ; in. Aeon., 
 Alum., Ars., Asaj-., Bell., Bry., Calc.c, Canth., Grap., JC. ca., Merc, Na. m., 
 Pul., Sabi., Sep., Sil. ; ON, Aeon., Aga. m., Aloe, Alum., Angu., Ant. cr.. Apis, 
 Am., Ars., Asar., Bro., Bry., Calc. c, Calc. ostr., Gamph., Ganth., Garb, v., 
 Ginch., Gle., Grap., Hep., Ig., K. ca., Kre., Mag. c, Merc, A^a. m., Nitr., Olnd., 
 Pul., Rhodo., Saba., Sabi., Sep., Spig., Spo., Zn. ; spreading from, Olnd., 
 Sep. ; as from a wind, Physo. 
 
 Herpes, extending from temple over whole ear down to the chest, at times 
 throwing off innumerable scales, and again showing painful rhagades, with 
 humid yellow discharges, forming scurfs, fetid, humid, intolerable itching, 
 especially in the evening till midnight. Pso. (1.) ; humid herpes, with swelling 
 of cervical glands, and livid, gray complexion, Kre. ; and around ears, with 
 ulcers, Gale p. 
 
 Inflammation. Garb, v., Jug. r., Kre., Merc. sol. ; with redness and great 
 soreness, Mag. c ; with inflammation of middle ear, Bell., Gale ostr., 
 Merc ; and discharge of pus, Bell, (r.) ; and redness, heat, and swelling, Pul. ; 
 stinging and tearing, Merc; red, hot, swollen, burning, proceeding from a 
 pimple in concha, with stiffness and pain in left side of neck, shoulder and 
 arm, Kre. (1.). 
 
 PrCHiNG. Arg., Aga. m., Benz. ac, Berb., Gale ostr., Garb, v., Gaus., Ghel., Gon., 
 Fl. ac, Grap., Hep., Mane, Mep., Mez., Na. p., Paeo , Phel., Rap. (1.), Sil., 
 Spig., Spira., 6"^/. ; i p.m., > scratching, 01. an.; 6 p.m., Grat. (1.); even- 
 ing. Gale p. ; after dinner, Phe. ; after riding, Gale p. ; in room, Gale p. ; 
 > scratching, Ghel.; with blisters, redness, and erysipelas, Mep,; heat 
 and redness, Hep. ; redness. Nit. ac. ; stitching, in evening, and swelling, 
 Gale e, Pho. ac. ; swelling, Nit. ac. ; as if they had been frozen, with burn- 
 ing redness, Aga. m. ; violent, with heat and redness, K. ca. ; with heat, 
 redness, and swelling, < night, Ail. ; forcing her to scratch until they bleed, 
 Arg. 
 
 Knots. Spo. 
 
 Livid Golor. Carbn. o.. Op. 
 
 Motion rapid and irregular. Aeon. (r.). 
 
 Numbness. Plat. ; extending to lips. Plat. (r.). 
 
 Pain. Fer. (1.), Petrol., Rhodo. (r.), Sul. (1.) ; NIGHT, Pho.; when lying on it. 
 Hep. ; with swelling. Garb. a. ; dragging, Anac, Rum. e ; tensive, with 
 swelling, Spo. ; ulcerative, Fer., Mag. e 
 
 Paleness. Amyg., Lau., Rhu. t. ; with coldness, Verat. v. 
 
 Pimples. Am. m., Berb., Gala. (1.), Gale p., K. ca., Mag. c, Mang., Merc, 
 Mur. ac, Pso. (r.), Sul. (r.) ; > evening, Petrol.; with itching, Berb.; pus- 
 
EA A' ; EX TERN A L . — PINCHING. — ^ / VEILING. 2 1 1 
 
 tules, and pulsation in ear, which creaks when lying on affected side, Spo. ; 
 INFLAMED, SORE, Cannab. s. (r.) ; oozing, with swelling, Spo. 
 
 Pinching. Angu., K. ca. ; < rubbing, Mang. (1.). 
 
 Pressure. Anac. 
 
 Pulling their ears constantly, < evening, Pul. (< 1.). 
 
 Pulsation. Merc. i. f. (1.) ; while sitting after dinner, Indg. 
 
 Purple Color. Apis, Sec. c. 
 
 Redness. Aeon., Aga. m., Alum., Ant. cr. (1.), Asaf., Bell., Bry., Calc. p., 
 Camph., Canth., Carb. v., Cinch., Der., Glo., Grap., Hep., Ig., Ind., Jab., Jug. r., 
 K. ca., K. n., Kre., Lye, Mane, Merc, Nitr., Nit. ox., Peti., Petrol., Pho., Plat., 
 PuL, Sep., Spira., Spo. ; afternoon. Cane. £., Na. m. (r.) ; evening. Alum., 
 Carb. V. (1.), Elap., Oena., Rap., Rhu. v., Sep., Spire., Tab., Tarent., Trom.. 
 Vesp. ; WITH blisters, itching, and erysipelas, Mep.; heat, Ahafi., Ant. cr., 
 Carb. v.. Hip., Kre., Mag. c. Mane, Mep.,Na. m., Nitr., Peti. (1.), Pho., Pul., 
 Sep., Tab.; evenings. Alum, (r., then 1.); every evening, Carb. v. (r.); heat 
 and itching, Hep., K. ca., as if they had been frozen, Aga. m. ; heat, itching, 
 and swelling, < night, Ail.; itching, K. ca., Nit. ac. ; inflammation, Kre., 
 Mag. c, and great soreness, Mag. c. ; suppuration. Nit. ac. ; swelling. Apis 
 (r. and 1.), Pul. ; warmth, Plat. ; cold stage, Bell., Pul. ; bluish, Tel., Tell. 
 (1 ) ; and looking as if infiltrated with water, with discharge, Tel. ; ERYSIPE- 
 LATOUS, Ars., Rhu. t. ; LURID, Rhu. t. r dark scarlet, > sneezing, Chlol. 
 
 Scabs. Bell., Bor., Bov., Elap., Grap., lod.. Lye, Pul., Sarr., Sil., Spig., Spo., 
 Sul.; with swellings, Ars.; humid, suppurating, and behind ear. Lye. 
 
 Scurfs. Cinnb. (r.). Cop. (1.), Sul. ac. (1.) ; and behind ear, Hep.; and humid 
 scurfs behind ear, Pso. 
 
 Sensitiveness. Lach.; to pressure, remaining long, Mag. c. ; to touch, Mur. 
 ac. Rap. ; to wind, draught, etc., Cham., Lach. 
 
 Skin over, feeling of a thin, with warmth. Asar. 
 
 Soreness. Aeon., Bry., K. ca., Mang., Merc, Mur. ac. (r.), Petrol. ; extending 
 towards temples, For. 
 
 Stiffness. Hydrphb. 
 
 Stitches. Chel. (r.), Fer. ma., Ol. an. (1.), Sul. ac (r.) ; on pressure, with 
 burning and swelling, Nitr. Pho. ; swelling, Spo., and itching, in evening, 
 Calc c, Pho. ac. ; extending inward, night on entering house, Thu. (r.). 
 
 Suppuration. Spo. ; with redness, Nit. ac. ; burning, and around ear, Cic v. 
 
 Sweat. Pul. 
 
 Swelling. Anac, Ajtf. cr., Calc. c. Cans., Crot. c (r.), Grap., K. ca., Kre., Lye, 
 Merc, Na. m., Nitr., Nit. ac, Pho. ac, Pul., Rhu. t., Rhu. v. (1.), Sep., Sil., 
 Spo., Zn. ; WITH blisters about ears, Ars.; burning and heat, Na. m.; burn- 
 ing and stitches on pressure, Nitr., Pho. ; crawling, Spo. ; discharge, Bor., 
 Cist., Sil. ; eruptions, Sep. ; copious earwax, Calc. ostr., Na. m. ; heat, Na. 
 m., Pho. ac, Pul., Zn. ; heat, redness, and itching, < night. Ail. ; inflammation 
 and tearing stitches, especially in children, Zn. ; itching. Nit. ac. ; itching and 
 stitching, in evening, Calc. c, Pho. ac; pain, Anac, Cans., Carb. a., and in 
 head, Pso. ; drawing-together pain, Cans. ; tensive pain, Spo. ; oozing pim- 
 ple, Spo. ; redness. Apis (r. and 1.), Pul. ; scabs, Ars. ; stitches, Sj^o. ; ten- 
 sion. Cans. ; on and around, and on side of face, swelling like erysipelas, 
 then running over the scalp, horribly painful to touch, Phyto. 
 
2 1 2 EAR : EXTERiYAL. — SWOLLEN. — CONCHA. 
 
 Swollen Sensation. Lach. 
 
 Tearing. Anac. (1.), Bell., Con., Mur. ac. (r.), Pho. ac, Sul. ac. (r.) ; and in 
 middle ear, Mag. m.. Rat. ; in middle ear and cartilage, K. ca. ; straining, 
 Bov. 
 
 Tension. Thu., Vio. o. (1.) ; with swelling, Caus. 
 
 Tetter. Sep. ; and around ear, extending to external meatus, Cist. 
 
 TicklinCx. Colocn. (1.). 
 
 Tingling. Stry. 
 
 Twinging, and in middle ear, Asar. 
 
 Twitching. Anac, Bor., Plat., Pul. ; and in middle ear, Dig.; cramp-like, 
 C/ua. 
 
 Ulcers. Bell. ; with discharge, Merc. ; and around ear, with herpes, Calc. p. ; 
 sensation of ulceration, Fer. (1.), K. ca. (r.). 
 
 Vesicles. Ars., Ars. (r.), Mep. (r.), Pte. (r.), Na. p. ; with redness, itching, 
 and erysipelas, Mep. ; coalescing, Ars. (r.) ; discharging water, Pte. (r.) ; 
 gangrenous, Ars. ; lenticular, Rhu. v. (r.) ; purulent, Ars. (r.) ; filled 
 with SERUM, Rhu. v.; surrounded by inflamed ease, Ars. (r.) ; trans- 
 parent. Alum, (r.) ; white, Pte. (r.) ; on red base, Pte. (r.). 
 
 "White. See Paleness. 
 
 Anterior Surface. Redness, Bry. ; near top, pimples, Coff. 
 
 Antihelix. Painful pimple, Am. m. (r.). 
 
 Antitragus. Itching, biting, Coc. c. (now r., now 1.) ; drawing, Sp(^. (1.) ; 
 PAIN, on pressure, extending into ear, Mur. ac ; pressure, drawing into 
 ear, Mur. ac; pimple, discharging like an ulcer, Spo. (r.) ; stiffness, Ki-e- 
 (1.); STITCHES on touch, Kre. (r.); biting, Coc. c (1.); jerking, Kre. (r.) ; 
 swelling, Kre. (r.) ; red, Spo. (r.); tearing, Berb.; thickened, Bry.; 
 tip, sticking and tearmg, Anac. (1.). 
 
 Cartilage. Bruised pain, Rut. ; drawing pain extending to neck, Pau. p. 
 (1.); tearing, and in external and middle ear, K. ca. ; sticking near rim, 
 Elat. (l.j. 
 
 Concha. Aching as if it had been pressed against the head, Mos. (1.) ; 
 extending mto drum, then to occipital protuberance, lb. ; wipes blood from, 
 in morning, Calc. s. (1.); bruised sensation internally. Ant, ; burning, K. 
 bi., Merc. sol. (1.), Mur. ac, Na. m. (1.), Op., Pho., Spig. (1.), (r.), Wies. ; 
 coldness, Thea; from a draught of air, Thea; of right, and burning heat of 
 left, which extends beyond the temple, with pain apparently in tympanum 
 with warmth, in evening, Na. n.; contraction, cramp-like, Anac. (1.) ; cut 
 TING extending to side of neck, Pau. p. (1.); drawing, Dro. (r.); cramp 
 like, Croc. ; sensation of drawing towards back of, Asaf. (1.) ; ERUPTION 
 Chin. ; HEAT, Arg. (1.), Lach., Na. m. (1.), Op., Pip. m. (1.) ; inflammation 
 Na m. (1.); erysipelatous, Tep. (1.); irritation, Mos. (r.); itching, Aga 
 m., Arg. (1.), Calc. c, Castor. (1.), Chel. (r.), Paeo., Ped. (r.), (1.), Rap., Spig 
 (r.), Sul. (r.), Wies.; evening when lying, Ped. (1.); burning, 9 p.m., > 
 scratching, Phel. (1.) ; tickling, K. n. (1.); JUMPING, twitching, Aga. m. (1.) 
 NEURALGIA extending to molars and cheek-bones, Thea; pain in evening 
 Mang. ; papules, Mur. ac. ; pimple with redness, heat, swelling and inflam 
 mation of external ear, and stiffness and pain in left side of neck, shoulder 
 and arm, Kre. (1.) ; pressure, Bry. (r.), Coc. c. (1.), Cup. (r.), Lach. ; drawing 
 
EAR : EXTERXAL, — COXCHA — Z OBE. 2 1 3 
 
 Sars. (r.) ; inward, Xa. m. (1.) ; tearing, Sars. (r.) ; > pressure, Bism. ; ruLSA- 
 TION, Fer. mu. ; suppurative, < boring in, Anac. ; redness, Arn., Xa. m. 
 (1.) ; SCAB, Mur. ac. ; sensibility lost, Lach. ; shooting, Stan, (r.) ; 
 SMARTING, Cannab. s. ; soreness, Spo., Zn. ; squeezed sensation, Calc. p. 
 (1.) ; stitches, Xa. c. (1.), Rhu. v. (r.) ; evening in bed, Thu. ; biting, > leav- 
 ing warm bed, Coc. c. ; fine, after dinner, Sul. (r ) ; squeezing, after dinner, 
 while sitting, Thu. (1.); swelling, Am., Xa. m. (1.), Pho , SiL, Tep. (1.), 
 TEARING, Cap., Chin., Cup. (1.), Hyos., K. ca. (r.). Lye. (1.), Pho. ac. (1.), 
 Thu. (1.) ; afternoon, Castor, (r.) ; evening, Indg. (r.), in bed, Thu.; 7.30 
 P.M., Mag. c. (1.) ; < pressure, Hyos. ; pulsative, < boring in, Anac. ; twitch- 
 ing, evening on lying down, > in bed, Ant. t. (r.j; tickling, Sul. ac. ; 
 TURNED around, sensation as if, in morning, Mag. s. (r.) ; twitching, Aga. 
 m. (r.), Calc. a., Pho, ac. (1.), Spig. (r.), Upa. ; ulceration, (Bry.) ; sensa- 
 tion of, in evening. Ant. t. (r.) ; VESICLES, Ars. (1.), Pho. 
 
 — Above, deep in brain, pressure, with complete faint-heartedness, Aga. m. 
 
 — Anterior wall, drawing, Pho. ac. ; eruf'^ion, Mos. (r.); itching, Mos. 
 
 (r.) ; > scratching. Chin. s. (1.) ; inflamed NODE with scab, painful to 
 touch, Spo. ; PRESSURE on motion, Pho. ac. ; whitish scales fall from, in 
 evening on scratching. Chin. s. (1.). 
 
 — Beneath, acute gnawing, Dro. 
 
 — External, boring, Lau. (r.) ; itching. Am. m. (r.), Coc. c. (r.) ; pressure, 
 
 tearing, > pressure, Eism. ; tearing at 10 a.m., Mag. c. (r ). 
 
 — Folds, formication, Arg. ; itching, and after scratching, burning soreness in 
 
 afternoon, Arg ; lower folds, stitches, > boring with finger, Coloc. (r.). 
 
 — Internal, cicatrix, red, Sabi. (1.); periodical itching. Ant. cr. ; pimple, 
 
 Xa. m. (1.) ; sore on pressure. Apis (1.) ; suppurating, Pso. ; redness. Ant. 
 cr. ; swelling, Ant. cr. ; dull tearings, Upa. (1.). 
 
 — Lower half, tearing pressure, Bell, (r.); tension, Thu. 
 
 — Margin, aching when lying. Pie. ; burning, Cala. ; evening in bed. Cans. ; 
 
 drawing, Asaf. (r.) ; inflammation, SiL; moisture, SiL; pain, Spig. 
 (1.) ; REDNE.SS, Am.; STICKING, Flat. (1.) ; < evening, Caus. ; swELLiN'r, 
 Arn., TEARING, Bov., Guai. (1.) ; tension', Eov. (r.); abou : helix, itch- 
 ing stitches, > touch, Ant. cr (r.) ; outer portion, constriction, Sars.; 
 tearing, Til.; upper, cutting, Lach. (1.); tearing, Anac. (r.). 
 
 — Posterior portion, pinching burning, Stap. (1.) ; cramp, Caic. a. ; draw- 
 
 ing, < touch, Coc. c. (1.) ; ITCHING, Aga. m. ; pain, Brv. ; PIMPLES, Aga. 
 m., pinching, Spig. (r.) ; pressure, Lye. (r.) ; stitch, on touch, Bry. (r.) ; 
 tearing. Bell. ; sticking, Meny. 
 
 — Upper part, burning. Con. (1.) ; heat spreading over side of head, 
 
 thence over face, Olnd. (r., then 1.) ; itching, Carb. v.; pimple, Kre (1.) ; 
 
 drawing stitch, Stan. (L). 
 Helix. Pimples, Ind. ; pinching, and in lobe, Flap.; ulceration, Grap. (1.), 
 Hollow. Stabs, Alum. 
 
 Inner Surface hot to touch, Bry. ; tickling, > scratching, 01. an. (r.). 
 Lobe, aching, Pho. 
 
 — Biting, Led.; followed by a node, Lach.; corroding. Plat. (1.). 
 
 — Boil, painful, and discharging matter and blood, Xa. m. (L). 
 
 — Bleeding in drops after rubbing, without a sore or pimple, Sil. 
 
214 EAR: EXTERNAL. — LOBE, BRUISED, REDNESS. 
 
 Lobe, Brufsed sensation, Chel. (1.), Crot. h.; with heat, Kre., Lach., Merc. 
 
 — Blfrninc;, Am. car, (1.), Arn., Bry., Cap., Carb. a., Carb. a. (r,), Carb. v., 
 
 Chel. (r.), K. n. (r.), Na. p. (r.), Nitr., Rhu. t., Saba., Sabi, (1.), Sars.; 
 WITH redness, Sabi.; twitching, inflammation, and swelling, Nitr. (r.) ; 
 TEARING, Carb. V. (I.). 
 
 — Cramp, Zn. (1.) ; extending into neck, on boring in finger, Zn. (1.). 
 
 — Dartings, twisting, Ton. 
 
 — Drawing, Ars., Dro. (r.), Pho., Sars. ; -with pulling, Sars. 
 ■ — Erosion, Arg. ; as from a caustic, wants rubbing, Plat. 
 
 — Eruption, Apis, Bar. c, K. ca., Sars.; dry, Elap. ; like herpes, Merc. 
 
 (r.) ; reddish and rough. Apis (1.). 
 
 — Freezing, in slight cold, Zn. 
 
 — Heat, Acon., Alum., Angu., Arn., Bry., Camph., Carb. a., Caus., Chin., 
 
 Cinch., Hyos., K. ca., Kre., Merc, sol., Na. m., Olnd., Saha., Sabi., Sil., 
 Sars.; evenings, Sil.; with bruised sensation, Kre., Lach, Merc; 
 inflammation, Nitr.; peevish and lachrymose mood. Alum.; heat of head, 
 SiL. ; alternately in right and left, spreading over same side, and 
 lastly over whole face, Olnd. ; burning, Rhu. t. 
 
 — Inflammation, Aga. m.. Alum., Ambra, Angu., Apis, Arg., Am., Ars., 
 
 Bar. C., Bro., Bry., Calc. ostr., Camph., Carb. a., Carb. v., Caus., Cham., 
 Chel., Cic. v.. Cinch., Crot, h., Colch., Dros., Grap., Hell., Hyos., K. bi., 
 K. ca., K. n. (r.), Kre., Lach., Lau., Mar., Mer]., Merc, Mur. ac, Na. c, 
 Na. m., Nitr , Nit. ac, Olnd., Pho., Pho. ac. Plat., Pb., Pso., Rhu. t., 
 Saba,, Sabi., Sars., Sep., Sil., Stan., Stry., *Tab., Thu., Ton., Verat., Zn. ; 
 after having been pierced, or when the rings have been torn out of the 
 ears, splitting and tearing the lobe, Nitr. (high) ; with swelling, burning, 
 and twitching, Nitr. (r.). 
 
 — Itching, Aga. m.. Alum., Arg., Ars., Asc. t, (r.), Bro., Caus., Grap., K. ca., 
 
 K. n. (r.), Lau. (1.), Na. m., Na. p. (r.), Pers., Pho. ac, Rhu. t. (r.), Saba., 
 Sars., Verat.; morning after rising, Arg.; at night on washing, K. bi. 
 (r.) ; (amel.) scratching, K. ca. (1.), Lau. (1.), Na. c. ; pressure and scratch- 
 ing, Na. m,, Pho. ac. (r.), Saba., Sars., Verat.; with itching on cheek, 
 Grap. ; sticking, Pho. ac. (r.) ; as from a tetter, Caus. ; with white, dry 
 scales, Mar. (r.) ; tickling, Aga. m. (1.). 
 
 — Lymph exudes after scratching, Grap. 
 
 — Nodules, Merc; preceded by biting, Lach.; of the size of a lentil, sore to 
 
 touch. Nit. ac. 
 
 — Pain, Carb. v., Chel., Dro., K. clc (r.), Merc sol., Mur. ac, Pho., Zn. ; 
 
 cramp-like, < boring, in ear with fi.nger, the same down neck, Zn. 
 
 — Pimples, Lach., Merc, sol.; burning, corroding, itching, moist, with a scaly 
 
 look, Merc. sol. (r.) ; painful, Merc. sol. ; lasting twelve weeks, Merl. 
 
 — Piercing, Stan. 
 
 — Pinching, and in helix, Elap. 
 
 — Pressure, Pip. m. (1.) ; > evening, Pho. 
 
 — Prickling, Rhu. t. 
 
 — Pulling, Sars. 
 
 — Redness, Caj., Camph., Cap., Chiii., Cinch., Cit. v., K. ca., K. n., Merc, sol., 
 
 Nitr.; with burning, Sabi,; heat, Camph.; redness of cheek, Cinch. 
 
EAR: EXTERNAL. — LOBE, SCAB. — MARGLN. 21 S 
 
 Lobe, Scab, burning and itching, Sars. 
 
 — Scales, Mar.; dry, white, with itching. Mar. (r.). 
 
 — Shooting, Kre., Na. m., Pho., Pho. ac, Pb., Saba., Tab., Zn. ; with stinging, 
 
 Saba. ; extremely painful and long lasting, Pso. 
 
 — Soreness on touch, Mur. ac, Nit. ac, Pho.; in evening, Pho.; > evening, 
 
 Pho. (r.) ; as if it would ulcerate, Mur. ac. 
 
 — Stitches, Carb. a., Lach., Na. c. (1.), Na. m., Pho., Pb., Pso. (\.), Sal>(7., 
 
 Saba, (r.), Tab., Ton., Zn. ; with shooting, Saba.; fine, Tab. (r.) ; itch- 
 ing, Nao c, Na. m. (r.) ; forenoon, > rubbing and pressure, Na. c. (1.) ; 
 throe RING, Pho. 
 
 — Swelling, Cit. v., K. n. (r.), Rhu t., R/iti.L {].), (r.). 
 
 — Tearing, Ars., Amdra, Canth., Carb a., Carb. v , Cham, (r.), Chin., Cic. v.. 
 
 Cinch., Cup., Guai., Lau., Mur. ac {!.), (r.), Pho, (r.), Stan., Tab. (r.), Verat., 
 Zn. ; DRAWING, Ars. (1.) ; fine, Tab. (r.) ; pinching, Stan. ; twitching, 
 Pho. ac ; evening and night, Na. slfc (1.) ; violent, Ambra (L). 
 
 — Tension, Thu. 
 
 — Tetter, Sep. 
 
 — Tickling, > scratching, Bro. (1.). 
 
 — Tumor, encysted, Nit. ac. (1.); sore on touch, Pers. (r.). 
 
 — Twitching, Nitr.; with burning, inflammation and swelling, NiTR. (r.) ; 
 
 fine, Pho. ac; visible, Sars. 
 
 — Ulceration, in hole for earring, Stan. ; as if beaten, Chel., Crot. h., Lach., 
 
 Merc. 
 
 — Vesicles, caused by discharge from ear, Tel. (1.); small, rough, red, 
 
 herpetic. Apis. 
 
 — Wind, sensation of cold, Stan. 
 
 — Before, pain, Buf. s. 
 
 — Behind, eruption, and on neck, Sep.; itching, Ment. pi. (r.) ; large nodes, 
 
 painless, with a white pimple on the top, Stap. ; pimple, sore, < touch, 
 Pho. ac. (r.) ; soreness on pressure, Mag. c (r.); acute stitch, > press- 
 ure, Na. c. (r.) ; pulsating, Pho.; tearing, Ambra; bone, pulsation and 
 ulceration, > pressure, Na. c (1.) ; periosteum, drawing, into cheek and 
 to lower jaw, Arg. (r.) ; FOSSA, drawing, Arg. (1.); extending downward 
 in a crescent from, during rest, Arg. (r.); pimple with white tip, Stap.; 
 pressure, Hell.; stitches into head, Arg. (r.); inward, Arg. (1.). 
 
 — Cartilage, griping tearing, Stan. (1.), 
 
 — Inner surface, itching, Arg. ; burning, Saba. 
 
 — Posterior surface, desquamation on scratching, Mez. (1.) ; burning itch- 
 
 ing, Mez. (1.) ; PIMPLE, sore on touch. Nit. ac; tension, Mez. (1.). 
 
 Lower Corner. Hard and painful swelling, Pip. m. (1.). 
 
 Lower Part oFc Itching, Rhu. v. (1.) ; pain, Arun. (1.) ; acute, extending to 
 cheek and neck. Am. br. ; soreness on touch, Thu. (r.) ; swelling, Thu. 
 (r.). 
 
 Margin. Burning, Sabi. (1.) ; itching, Ol. an. (r.) ; 4 p.m., > rubbing, 01. an. 
 (r.) ; pimple, burning, sticking, bleeding, after rubbing, with itching, > 
 touch, Na. in. (r, and 1.); SCALES, Bry. ; soreness, Bry. ; tearing. Til. 
 (r.); tickling, Bro. (r.); anterior margin, burning. Alum, (r.) ; tearing, 
 K. ca. (r.); skin of margin, dry, thickened, and white, Bry. 
 
2l6 EAR' EXTERNAL. — MEATUS, ACHING, DISCHARGE. 
 
 Meatus, Aching. Na. p. (r.), Tel. (1.), Thu., Verat. 
 
 — Air (including wind), sensation of, evening, Mez. (r.) ; < yawning, > 
 
 boring in, Mez. (r.) ; as if free access were prevented, forenoon, 
 Thu. (r.) ; air entering, Amph. ; when opening and shutting mouth, 
 Thu.; with desire to bore in, Mez.; with stitches to the eyes, Pul.; cold 
 AIR, Dul., Plat.; rushing in. Lachn. ; out when laughing, Mil. (1.) ; rush- 
 ing out. Bell., Canth., Chel., Pso. (1.), Rhu. t. (r.), Stan., Stram.; after 
 whistling and ringing, Vine. mim. ; hot, ^th.. Par. 
 
 — Blisters, Nice. (1.). 
 
 — Boring, Merc. i. f. (r.), Sul., Upa. (r.); evening. Ran. s. (1.); desire for, 
 
 Aga. m. (1.), Arun., Colch., Mez. (r.) ; in evening, Physo. ; with feeling as 
 if the ears were too open, and air were rushing, or as if tympanum were 
 exposed to cold air, Mez. ; pain, later bruised pain from pressure, Caus. 
 (r.). 
 
 — Burning, Arun. ; itching, Mag. m. 
 
 — Closed sensation, > boring finger in, Spig. 
 
 — Coldness, Mez. (r.) ; with moisture, Merc, sol.; in a small spot, Chr. ox. 
 
 (1.) ; as from a wind, Caus. (r.), Stap. (r.), 
 
 — Compression, Asaf. 
 
 — Constriction, < removing wax, Bry. 
 
 — Contraction, Bry. ; cramp-like, Anac. (I.). 
 
 — Cramp, Anac, Fer. mu. ; < drawing scalp down from highest point of 
 
 skull, Thu. (r.). 
 
 — Crawling, > boring in. Mil. (1.). 
 
 — Denuded, Merc. sol. (< r.). 
 
 — Dilatation, sensation of, Mez. (r.) ; morning on putting in finger, Mez. 
 
 (r.) ; in EVENING, Mez. (r.) ; < yawning, > boring finger in, Mez. (r.) ; by 
 
 AIR, MEZ. (r. and 1.). 
 Meatus, Discharge, ^s., Agn., All. c. Aloe, Ahim., Alum, (r.), Ambra, 
 Am. car., Am. m., Anac, Ant t.. Apis, Ars., Ars. (1.), Arg. n., Ars. i., Asa/., 
 AUR., Bap., Bell., Benz. ac, Berb., Bor., Bor. (1.), Brach., Bro., Bov., Bry., 
 Cact., Calc. ostr., Calc. ostr. (r.), Cale., Cale. (1.), Carb. a., Carb, a. (r.), 
 Carb. V , Cans., Cham., Chim., Cic. v., Cina., Cist., Colch., Con., Croc, 
 Elap., Elap. (1.), Eup. p.. Gel., Grap., Hep., Hydrs., led., Ir. v., K. Bi., K. 
 ca.. Kin., Kre., Lach., Lachn., Lith , Lyc, Menv., Merc, ]\Ierc. c, Merc, 
 sol., Murx., Na. m., Mos., Nit. ac, Petrol., Pho., Pho. ac, Phyt., Pso., 
 Pul., Pul. (l), Pul. n.. Rum. c, Rhu. t., Sa77g, Sel., Sen., Sep., Sil., ^/^., 
 Stil., Sul., Sul. (1.), Tel., Tel. (1.), Thu., Thu. (r.). Vac, Verat. v., Zn., 
 Zn. (1.), Xan. ; in afternoon, Bry. ; night, Sep. (r.) ; in warm bed, Merc, 
 sol.; after acute eruption, Meny. ; after itch, Carb. v.; after measles, 
 Colch., Meny.; after abuse of mercury, Asaf., Aur. ; itching on occiput, 
 Bor. ; after scarlatina, K. bi., Lyc, Meny. ; after spattering, Spig ; sup- 
 posed to be from vaccin.ation, Vac; children are better when it runs, 
 worse if not, Sul. ; with delicate white skin, Caus. ; in several young persons, 
 Sul.; with throbbing in ears, Tel.; with coldness, Merc, sol.; caries of 
 mastoid process and ossicula, Aur., Fl. ac. ; inflammation of external meatus, 
 Caus., K. ca., Sep., Sil., Sul., and of membrana tympani, Carb. v.; sensitive- 
 ness to touch, Carb. v., Cham. ; swelling of outer ear, Bor., Cist. ; itching in 
 
EAR: EXTERNAL. — MEATUS, DISCHARGE. 21/ 
 
 ears, Anac, Bor., Merc, Petrol., vSep. ; and eruption, Sul.; itching and swell- 
 ing, Tel.; swelling, Caus., Cist.; external swelling, Sil.; bluish red color of 
 ear, and looking as if infiltrated with water, Tel.; ulceration of inner ear, 
 Lye, of outer ear, Merc; tearing pain, Colch., Merc, after measles, Colch. ; 
 with pain from ear down neck when turning head, Carb. v. ; noise in ears, 
 Calc ostr. ; roaring, Bor.; hard hearing. Am. m., Asaf., Calc ostr., Carb. v.; 
 Caus., Elap., Lye, Sil., Tel.; with headache, Pso. ; shooting in head, 
 Bor., in forehead, Elap. ; burning pain on outer head, extending down neck, 
 Carb. v.; flow of TEARS, Elap.; eruption on FACE, Sul.; vesicles, Merc; 
 paralysis of face, Caus. ; large abdomen, Calc ostr.; swollen glands in 
 NECK, Calc. ostr. ; vesicular eruption on neck when the discharge touches 
 the skin, Tel.; pustules on lower limbs, Merc. s. ; little warts on hands and 
 fingers, Calc. ostr.; swelling of knee, Sil.; prostration and sinking, Ars. ; 
 desire to be uncovered. Lye, Pul., Spig., Sul. 
 Meatus, Discharge, Followed by hard hearing, Bor. 
 
 Bloody, Am. car., Arun. (1.), Bell., Bry.., Calc, ostr., Caus., Cic. v., Con., 
 
 Cj'ot. h., Elap., Ery. a. (1.), Grap., Ham. (r.). Each., Lyc, Merc, Merc. 
 s. (r.), Mos.,vV>/. ac, Petrol., Petrol. (< 1.), Pho., Pid., Rhu. t., Sep., 
 Sil., Sid., Zn. ; in drops, Mos. (r ) ; after a sound as of a cannon, Mos. ; 
 OOZING, Crot. h., Pho. ; morning, Merc. s. (1.) ; RUNNING from ear, Bell., 
 Bry., Calc. s., Cic. v., Con., Cic v., Grap., Each., Lyc, Merc, Mos., 
 Nit. AC, Petrol., Pho., Pul., Rhu. t., Sep., Sil., Sul., Zn.; suddenly, 
 Crot. h. ; if the ears run blood, the child makes less water, Carb. caus., 
 Colch., Lyc, M.^xz., Pho., Pul.; spurting, Cary., Cic. v.; of arterial, 
 Elap.; and from nose, Elap.; and purulent, Cannab. s. (r.), Caus., 
 Ery. a. (1.), Merc sol. (r.), Petrol., Rhu. t. 
 
 Brown, Anac, Tarent. (r.) ; thick, Carb. v. 
 
 Cadaverous, Ars., Thu. 
 
 Catarrhal, every seventh day, Sul. 
 
 Clear, Bry. 
 
 Corroding, Ars., Calc. ostr., Calc ph., Hep., Lyc, Merc, Sul., Tel., Tel. 
 
 (1.) ; causing eruption, intertrigo behind ear, itching and bleeding after 
 scratching, Sul. 
 
 Flesh-colored, offensive, Carb. v. (r.), K.'ca., Zn. (1.). 
 
 Fluid, see watery. 
 
 Green, after scarlet-fever, without pain, Bov. ; yellowish, in morning, Elap. 
 
 Lymph, oozing of, with itching in ear, Grap. 
 
 Mild, not corroding, and without smell, Pho. 
 
 Mucous, Alum., Bell., Bon., Bor., Calc ostr., Grap., Lyc, Merc, Pho., 
 
 Pul., Sul., Tarent (r.) ; fetid, Calc. ostr.. Each., Sul. 
 
 Offensive, Ars., Asaf., Aur., Bov., Calc. ostr., Carb. v., Carb. v. (r.), Caus., 
 
 Cist., Ery. a. (1.), Grap., Hep., Hyos., K. ca.. Each., Lyc, Merc, Merc, c, 
 Merc sol. (r.), Nup., Pso., Sep., Sul., Tel., Thu., Zn., Zn. (1.) ; with 
 itchmg and deafness, Bov. ; with itching in ear, and swelling of lobe, Tel. 
 — — Purulent, Aeon. (1.), /Eth., Alum., Alum, (r.). All. c. Am. car., Am. 
 m., Arun., Ars., Asaf., Aur., Bell., Bor., Bor. (r.), Bov., Calc. c, 
 Calc ostr., ( arb. a., Carb. v., Caus.. Cham., Cist., Con., Cop. (1 ), 
 Gel., Grap., Hep., Jug. r. (< 1.), K. bi., K. ca., Each., Lyc, ArEKc, Na. 
 
21 8 EAR: EXTERNAL. — MEATUS, DISCHARGE. ITCHING. 
 
 M., Nit. AC, Petrol., Pho., Pso., Pul., Rhu. t., Sac, Sep., Sil., Sul., 
 Tep., Zn., Zn. (1.); DAY and night, Zn. ; with hard hearing, Asaf., 
 Bor., Pul., at times, Sul. ; inflammation of external and internal ear. Pell, 
 (r.) ; lancinating pains. Bell., Cham., Chin.; otitis, Bell.; swelling in 
 meatus and otitis, Pul. ; AND bloody, Cannab. s. (r.), Caus., Ery. a. (1.), 
 Merc. sol. (r.). Petrol., Rhu. t. ; with burning in ear, Pul.; with burning 
 pain, Chin., Pul. ; and brownish, Anac. ; and fetid, Cist., Merc, Merc. 
 SOL. (r.), Pso., Sep. ; with hard hearing, Asaf., Aur., Bov.; profuse, with 
 cadaverous odor, Ars. ; and thick and yellow, from both ears, after 
 scarlet-fever, K. bi. ; and white, Ery. a. (1.) ; and yellow, Merc. sol. 
 (1); smelling, Bj-y. 
 
 Meatus, Discharge, Thick, Carb. v. (r.), Ery. a. (1.), Tarent. (1.) ; and 
 brown, Carb. v., Carb. v. (r.). 
 
 Watery (including fluid, thin, etc.), Asaf., Bell., Calc. ostr., Carb. a., 
 
 Caus., Cist., Elap., Elap. (1.), Kre., Mfny., Merc, Na. m.. Nit. ac, 
 Pho., Sep., Sil., Spig., Tarent. (r.), Tel. (1.); in morning, Elap.; and 
 cadaverous, Ars. ; dripping, Rhu. t. ; smelling like fish-pickle, Tel. ; 
 oozing, like putrid meat, Thu. ; and yellowish, K. slfc. ; with 
 blotches in throat, Elap. 
 
 White and purulent, Ery. a. (1.). 
 
 Yellow, Merc, Na. m., Pho. ; greenish, Elap., Gel., Pul. ; and watery, K. 
 
 slfc. 
 
 Sensation of, Aga. m., Merc, Sil. (1.); at night. Pry.; with drawing 
 
 pain. Mil. (1.) ; of water, Aeon. (1.), Calc. c, Chr. ac. (r.), Cinnb., Der., 
 Grap. (1.), Mil. (1.), Merc, sol., Tel. (1.) ; after dinner, Thu. (r.) ; cold 
 water, Merc. sol. ; tenacious liquid, Na. m. ; sensation as if about to 
 discharge, Lachn. ; afternoon and evening, Hip. (1.). 
 
 Meatus, Drawing. Anac (1.), Asaf., Chel. (1.), Dul., Nit. ac, Sil.; in even- 
 ing, Coc c. (r.). Ran. s. (1.) ; with sensation of a discharge. Mil. (1.) ; 
 cramp-like. Croc; extending backward, noon. Aloe (r.) ; outward, Sul. 
 ac. (r.) ; into temple, Chel. (1.) ; SUDDEN, Coc. c (r.). 
 
 — Dryness, see wax, want of. 
 
 — Excre.scence, fungous, Merc. 
 
 — Flea in, sensation of, Haem. 
 
 — Fly in, sensation of, Elap. 
 
 — Foreign budy in, sensation of, Cane f. (r.), Pho.; before drum, Calc. a. 
 
 — Formication, Ant. cr. (r.), Sul. (1.); > boring in with finger, Mil. (1.), 
 
 Ton. (r.) ; biting, Plat, (r.) ; deep-seated, Ars., Lau. 
 
 — Fulness, Cinnb. (1.). 
 
 — Gnawing, Sul. (1.). 
 
 — Heat, Asar. (r.), Chel. (r.) ; rushing in. Ant. cr., Lye; rushing out, TEth., 
 
 Calc. c (1.), Cle., K. ca., Ol. an.. Par. ; after two beats in ear, Ol. an. 
 
 — Herpes, habitual, with hard hearing, Grap. 
 
 — Inflammation, Arun., Mag. c. (r.), Petrol.; with soreness, Merc; swell- 
 
 ing, Calc. ostr.. Cist., K. ca., Na. m., Sep., Tel., Thu., Zn. a. 
 
 — Itching, Aga. ni. (r.), (1.), Alum., Arun., Bov., Coc. c (1.), (r.), Elap. (r.), 
 
 Fago. (1.), Fer. mu., Fl. ac, /<'-., K. n., Lau., Mag. c (r.), Mane (r.), Merc. 
 d., Merc i. r. (r.), Mil. (r.), Na. p. (r.), Ol. an., Phe., Sars. (1.), Sil., Sul. 
 
EAR: EXTERXAL. — MEATUS, ITCHEVG, STITCHES. 219 
 
 (1.), Zn. ; in forenoon, Fagn. ; 2 P.M., Fago. (r.) ; evening, Flap.; after 
 oozing of LYMPH, Grap. ; (amel.) boring in with finger, Bov., Coc. c. (!.)> 
 Fl. ac, Lau., Mil. (r.), Ol. an., Phe., Zn. (r.) ; scratching, Mag. c. (r.) ; 
 ACUTE, > touch, Hype, (r.) ; alternately in one or other, Chel. ; child 
 BORES in, Fl. ac, Mez. ; itching of ears internally, Dios. ; in ear inter- 
 nally and externally, Spira. ; inside ear in evening. Flap., Murx. ; of ear 
 internally, 10.30 p.m., Dios. (r.), (1.); burning, Arun.: deep-seated, 
 8 p.m.. Rum. c. (r.) ; extending deeper on boring in with finger, Phe.; 
 to interior of cheek, in course of Steno's duct, Flap.; tickling, K. n. 
 (r.) ; > boring with finger, Aga. m. (1.) ; VOLUPTUOUS, extenaing through 
 inner ear to mouth, Coc. c. 
 Meatus, Lancination, Ast., Crot. c. 
 
 — Membrane stretched across, sensation of, Asar., Asar. (r.) ; < cold 
 
 weather, Asar. 
 
 — Pain, Abs. (1.), Aloe (1.), Apoc. c, Arun., Asa/., Chei (1.), Cinnb. (1.), 
 
 Haem., Merc. i. f. (r.), Spira., Sum.; in evening. Cans, (r.) ; on boring 
 in with finger, Rhodo. (i.) ; on touching, Tab, Zn. ac. (1.); < pressing 
 TEETH together, Aloe (1.); acute, Merc. i. f. (r.) ; spasmodic, Anac. ; 
 sudden, Merc. i. f. (r.). 
 
 — Picking in, Bov. (1.), Dro., Dro. (r.). 
 
 — Pimple, Jug. r. 
 
 — Polypus, Calc. ostr., Dul., Merc, Stap., Thu.; stinking, tincture Calc. 
 
 in water, lime-water. 
 
 — Pressure, Asaf. (r.). Bell., Chel. (r.), Coc. c, Rhe., Sil.; with tension, 
 
 extending to left lower jaw, and salivation on right side, Asar. ; DRAW- 
 ING, Bism. (1.) ; extending, to right lower jaw, Asar. (r.) ; as from a 
 finger, < stooping when reading, Bry. ; inward, Spig. ; sticking, Xx. 
 v.; TEARING, Sars. (r.) ; tensive, < cold weather, Asar.; towards, Op.; 
 against tympanum, Anac. (1.), 
 
 — Pulsation, Tel. (1.). 
 
 — Pustules, Pie. (r.) ; sore, Cannab. s. (r.). Gas (1.). 
 
 — Redness, Mag. c. (r.) ; with swelling, stitching, and tearing in ear, and 
 
 catarrhal affection of Fustachian tube, Pul. 
 
 — Relaxed sensation, in morning on putting in finger, Mez. (r.). 
 
 — Rushing out of something warm, Sul. ac. 
 
 — Shooting, Bell. ; evening in open air, Sul. (r.) ; cool, Fer. mu. 
 
 — Soreness, Fago. (1.), K. bi. (I.), Merc. sol. (<r.) ; on cleaning ear, Caus.; 
 
 on PRESSURE, Mag. r. (r.) ; on touch, Fago. (1.), Na. m. ; in a spot, Sel. 
 (1.) ; WITH inflammation, Merc. 
 
 — Spasmodic sensation, Cham. 
 
 — Stench without discharge, Aur., Bov., Carb v., Caus., Cist., Grap., Hep., 
 
 Hyos., Merc, Pso., Zn. 
 
 — Stitches, Aeon, (r.), Aga. m. (1.), Angu., Arun., Bry. (r.), Carbn. s., Carb. 
 
 V. (r.), Cham., Chel. (r.), (1.), Crot. c. Did., K. bi. (r.), Pso., Ran. s. (r.), 
 Tarent. (r.) ; NOON, sitting, Gel.; afternoon, after descending stairs. 
 Chin. s. (1.); evening, during rest, Pso.; when chewing, Cannab. s. ; 
 > boring with finger, Pso.; with narrow feeling, Lye; stinging, 
 Camph. (1.); ACUTE, Cham, (r.), Pho. (r.) ; BITING, Coc. c. (r.) ; dR-AW- 
 
220 EAR: EXTERNAL. — MEATUS, STOPPED, WAX. 
 
 ING, extending outward, Calc. caus. (I.), over outer portion, Kre. (].); 
 DULL, Plat, (r.) ; EXTENDING inward, Carb. v. (1.); at 5 p.m., while walk- 
 ing, K. bi. (r.) ; outward, at night, Ars. (1.) ; FINE, Na. m. (r.) ; inter- 
 mitting. Plat, (r.) ; PRESSING, Thu. (r.) ; TICKLING, Wies. ; deep-seated, 
 Dro. (r.). 
 Meatus, Stopped sensation, from without, Ars. (1.) ; by a swelling, with 
 cramp-like sticking internally and externally, Merc. SOL. 
 
 — Suppuration, feeling of, Mag. c. (r.). 
 
 — Sweat, Sul. (1.). 
 
 — Swp:lling, 13ry., Calc. c, Caus., Cannab. s., Na. m.. Petrol.; with inflamma- 
 
 tion, Calc. ostr.. Cist., K. ca., Na. m., Sep., Tel., Thu., Zn. a., and purulent 
 discharge, Pul.; pain, Mez. (r.), Petrol., on touch, Zn. ac. (1.); redness, 
 Zn. ac. (1.) ; redness, stitching, and tearing in ear, and catarrhal affection 
 of Eustachian tube, Pul.; sensation of, June; in evening, Mez. (1.). 
 
 — Tearing, Canth. (r.), Chel. (r.), Chin., Colch. (r.), Indg. (1.), K. n. (r.), Lye. 
 
 (r. and 1.), Stan, (r.), Tarax., Ton. ; extending to upper jaw, caused 
 and < cold air, Aga. m. (r.) ; fine, Phel. (r.) ; intermittent, Pso. ; 
 pressive, Aur. (1.) ; sticking outwardj < towards evening, Ars. (1.). 
 ■ — Tension, Asaf. (r.), K. n. (r.) ; with pressure, extending to left lower jaw, 
 and salivation on right side, Asar. ; pressive, Asar. 
 
 — Tickling, Coc. c. (1.), Na. c. (L), Rhodo. (1.); extending through inner ear 
 
 to mouth, Coc. c. ; at 8.30 a.m., Na. c. (1.) ; > scratching, Na. c. (1.) ; 
 voluptuous, Ars. 
 
 — Tingling, Alum. 
 
 — Twinging, Anac. (r.) ; in evening, Mez. (1.). 
 
 — Twitching, Anac. (1.), Nit. ac, Val. (r.) ; tearing, Carb. v. (r.). 
 
 — Ulcers, Alum., Bov. (r.), (Bry.), Caviph., Grap. (1.), Kali., Merc , Pul., Rut., 
 
 Spo., Stan.; WITH discharge. Lye; pain on swallowing, Bov. (r.) ; red, 
 with sticking pressure on touch, Camph. ; sensation of, on cleaning ear, 
 Caus. ; on putting on finger, Sep. 
 
 — Vapor, sensation of a hot, coming from, Canth., Par.; going in, Euphr. (r.). 
 
 — Water rushing in, sensation of, with a large quantity of thick or thin 
 
 wax, Lye. 
 
 — Wax, abundant (including increased), Aga. m., Am. m.. Bell., Calc. c, 
 
 Calc. ostr., Carb. v., Cham., Coca (r.), Colch., Con., Cyc, Elap., Grap., 
 Hep., lod.. A", ca., Lack., Lye, Merc, Merc. i. r., Mos., Mos. (1.), Mur. ac. 
 Nit. ac. Petrol., Pho., Sed., Sel., Sel. (1.), Sep., Sil., Sul. (<1.), Tarent. 
 (r.), Tel., Thu., Wies., Zn., Zn. (1.) ; with gurgling, K. ca. ; with dull hear- 
 ing, Mur. ac, Zn. o. ;,with itching, in forenoon, Cyc, Mur. ac, Sep. ; with 
 roaring, Mur. ac, Sep.; with rushing as of water, Lye, Petrol.; with 
 swelling of outer ear, Calc. ostr., Na. m. ; in balls, Dios. (r.), Elap.; 
 BLACK, Elap.; and hardened, Elap., Pul.; with hard hearing, Pul.; dark 
 BROWN, in evening, Calc. s. (r.) ; dark and hard, Mur. ac. ; dry, .Eth., 
 Carb. v.. Cast, eq., Cham., Colch., Grap., Each,, Mur. ac. Nit. ac, Petrol., 
 Pho.; with buzzing, Pho.; with hard hearing. Each.; with swelling of 
 ear, Nit. ac. ; with or without rushing, Pho. ac. ; with hard hearing (after 
 Sul.), Each.; FLOWING out, Wies.; at night, Mos. (r.) ; with itching, Am. 
 m., Anac, Petrol. ; roaring, Grap. ; flowing in Eustachian tube, Crot. h., 
 
EAR: EXTERNAL. — MEATUS, WEDGE. — POSTERIOR. 22 L 
 
 Lacb.; fluid, Am. m., K. ca., Merc, s., Sil., Sul., Tel., Wies., Zn. o. ; 
 running out, Am. m., Con., lod., K. CA., Lach., 2\Ierc., Mos. (r.), Sel. ; 
 HARD, Elap., Sel., Sel. (1.); with hard hearing, Sel.; mushy, Chel. ; like 
 rye-mush, pap, Lach.; PALE, Wies.; like chewed paper, with hard 
 hearing, Con.; like shreds of mouldy paper. Con.; purulent, Sep.; 
 REDDISH, Pso. (1.); blood-red, Con.; brown red, dry and hard, Mur. ac. ; 
 slimy, Wies.; soft, Sil. (r.), Wies.; thick, Chel.; viscid, Sul.; want 
 OF, .-tth., Alco., Berb. (1.), Bon., Calc. ostr., Curb, v., Castor., Cham., 
 Grap., led., Lach., Mur. ac, Xit. ac. Petrol., Pho. ; with beating, Berb. ; 
 with inclination to bore in, Colch. ; with bubbling, Berb.; with hard 
 hearing, Grap., Mur. ac. ; whitish, Chel., Sep.; accumulates, with itch- 
 ing, Sep.; yellow, K. ca. ; fluid, SiL. ; sensation as if increased, 
 Aga. m., Calc. ostr., CoN., Cyc, Hep., Petrol., Sel., Sep., Sil., Thu. ;. 
 sensation as if flowing, Aga. m. ; SENSATION AS IF it would flow into 
 mouth, Crot. h. ; would flow out, on swallowing saliva, Coc c (1.). 
 Meatl'S, Wfdge driven in, sensation of, evening while walking in open air, > 
 boring with finger. Par. (<r.). 
 
 — Wind, see air. 
 
 — Yawning, sensation as from, Olnd. 
 
 — Antitragus, near, stitches on pressure, Sep. 
 
 — Before, contraction, Cham.; sticking itching, Caus. (r.) ; stitches, 
 
 Cham.; tearing and twitching, Dro. (1.). 
 
 — Cartilage, tickling, morning in bed, K. n. (r.). 
 
 — Entrance, burning, Olnd. (1.), Spo. (r.) ; dragging towards, Crot. t.; 
 
 eruption, burning and itching, Rhu. t. ; heat, Zn. (1.) ; itching, Caus.. 
 in bed, Verat. v. (1.) ; pain, Hype, (r.) ; < touch, Parent. ; feeling as if 
 a NAIL were driven through head, < touch, Parent. ; inflamed node, 
 Spo. (1.); swelling, Sep., Zn. (1.); inflamed, K. hi. (1); with tension 
 and crawling, Spo. ; pleasant tickling, and on wmgs of nose, alter- 
 nating with crawling and itching at anus, Saba. ; twisting towards, 
 Crot. t. ; IN region of, pressure and tension, Asar. 
 
 — Externally, abscess, with right-sided headache, Merc; pain as if air 
 
 were rushing in, Amph. ; inflammation, Aeon., Pho. ac. ; with discharge, 
 Caus., K. ca. Sep., Sil., Sul.; itching, Caus., Ig., Nitr. ; moisture, with 
 hard hearing, Merc. ; narro\ving, Mang. ; suppuration, with inflam- 
 mation of ear. Kin.; s\velling with inflammation, K. bi. (1 ). 
 
 — Internally, aching, Cup. ar. (r.) ; at night, in bed, Merc. i. f. (r.) ; bor- 
 
 ing, acute, intermittent, Merc. i. f. (r.) ; itching, Lob. s. (1.) ; pain, Cup. 
 ar (r.), Hydrc. (1.), Mez. (r.) ; pressure, intermittent, tearing, Chel. (r.) ; 
 swelling, painful, Mez. (r.) ; tearing. Amine (r.), Chel. (r.). 
 
 — Lower part, painful swelling, Mez. (r.). 
 
 — Close to meatus, squeezing pain, Sul. (1., then r.). 
 
 Membrana Tympani. Inflammation with discharge, Carb. v. ; violent draw- 
 ing shooting pain from stomach to, every time he laughs, Mang. ; pressure 
 inward upon drum, Vio. t. ; ulceration, thickening and destruction, Hep., 
 Merc 
 
 Muscle. Levator auris, tickling, > scratching, Bro. (r.). 
 
 Posterior Part, heat, Aloe. , itching, Mos. ; external pulsation, Aloe ; 
 
222 EAR : EXTERNAL. — SIDE. — ABOUT. 
 
 ROUGHNESS, Rhu. V. ; sensation of swelling, on turning head to left, Rap. ; 
 VESICLES exuding yellowish serum, Rhu. v. 
 
 Side, biting, Lye. (r.) ; lancinations, Tarent. (r.) ; soreness, Lye. (r.). 
 
 Skin, swelling, Rhu. v. 
 
 Skull, at union with, sensitiveness, Bry. 
 
 Tips, burning, Chel., Coloc. (1.) ; while the tip of the nose is cold, Chel. ; livid, 
 Op.; tearing in forenoon. Castor. (1.). 
 
 Top, drawing towards occiput, Sul. (1.) ; burning stitching, Calc. s. ; pimples, 
 Calc. s. (r.). 
 
 Tragus. Boil, Sul.; eruption, scurfy, with burning biting, Pul. ; neural- 
 gic PAIN, evening, Fago. ; stitches, extending into meatus, Cham, (r.) ; 
 TEARING, Nit. ac. ; inside, itching, Mur. ac. (1.) ; > scratching. Chin. s. (1.) ; 
 smarting pain, Mur. ac. (1.) ; before region of tragus, spasmodic sensation 
 sometimes into meatus, Cham. ; stitches, Cham, (r.) ; below, smarting pain 
 and itching pimples, Mur. ac. (1.). 
 
 Upper Part, burning. Apis (1.) ; pressure as with a plug, Bro. (1.) ; soreness 
 in evening on pressure, Mez. 
 
 About External Ear. Aching internally, Bro. (1., then r.) ; blisters with 
 swelling of external ear, Ars. ; boils. Am. car.; boring. Am. m. (1.), Bell, 
 (r.); bruised sensation extending down neck to clavicular and scapular 
 region, Coc. c. (1.) ; burning, Calc. c. ; coldness, as if in bones, ^th. (r.) ; 
 drawing, Asaf. (1.), Nit. ac. (1.) ; towards evening, Cle. (r.) ; upward and 
 downward in a spot, > pressure, Grat. (1.) ; fulness, and in ears, Glo. ; 
 heat, in evening, Ment. pi. (1.), and burning with hard hearing, Jac. ; 
 herpes and ulcers, and on external ear, Calc. p. ; itching, in evening, Ment. 
 pi. (1.); > rubbing, Phel. (1.); numb sensation, with hard hearing (after 
 Sul.), Lach. ; pain, Bry. (1.), Cane. f. (r.), K. ca., Merc. i. f. (r.) ; after a walk, 
 Pal. (r.); burning, Calc. ostr. ; extending upward, 01. an., Sars. ; pimples, (Ant 
 cr.), Mag., Ment. pi. (1.), Mur. ac. Petrol.; itching, Na. p. (r.) ; feeling as 
 if pimples would form, Tet. (1., then r.) ; pinching, extending towards eye, 
 Glo. (r.) ; pressure, ^s. h. (r.) ; redness, Arn. ; sensitiveness, and of ear 
 with inflammation, Merc. ; shooting extending to occiput, 7.30 p.m., Fago. 
 (r.) ; soreness as if in bone, Tet. ; spasmodic sensation, and in ears. Ran. 
 b. ; stitches, Asaf. (1.), Lepi. (r.) ; towards evening, Cle. (r.) ; extending 
 outward, morning till evening, Na. m. ; towards left eye, Glo. (r.) ; and in 
 ears. Con., Vio. o. ; burning suppurating, and on external ear, Cic. v.; 
 swelling, Arn., For.; with otitis, Pul.; tearing, Canth. (r.), Ton.; 
 bruised, Ery. a. ; extending upward and downward, in a spot, > pressure, 
 Grat. (I.); fine sticking, extending to top of head, /Eth. (1.); tearing with 
 stitches, and in head. Con.; tension. Am. car. (1.), Asaf., Grap. (1.); in 
 morning, Stry. ; with dulness and stupidity, Asar. ; tetters, and on exter- 
 nal ear, extending to meatus. Cist. ; twitches, Aga. m.. Am. car. (1.) ; 
 uncomfortable. For. ; ulcers, Calc. p. ; sensation of warm water flow- 
 ing from, Cala. ; bones, aching. Nit. ac. (1.) ; digging, at night, Mang. ; draw- 
 ing. Nit. ac. (1.) ; pain, Bry. ; shooting outward, Calc. p. ; sensation of swelling. 
 Aeon.; tearing, K. ca. (1.); head, dulness, ^Es. h. ; bursting sensation 
 when vomiting, Asar.; drawing. Nit. ac. (1 ) ; fulness, < out of doors, Linu. ; 
 lancinations at night, Tarent. ; sensation of something lying on, Plan. ; pain 
 
EAR: EXTERNAL. — ABOVE. — BEEORE. 223 
 
 extending from one ear to the other, Chel. ; pressure, Bry., extending across 
 vertex to other ear, Nit. ac. (1.); stitches, Pho.; tearing, Pho., Sul.; about 
 lower JAW, drawing, K. bi.. Petrol. ; stitches, K. bi., Lau. (r ) ; tearing, K. 
 ca. ; tension. Petrol.; twinges, Colch. (r.) ; external throat, pimples, Sul. 
 (1.) ; stitches, Hep. ; tearing, < pressure. Gam. (1.). 
 
 Above External Ear. Aching, Dul. (1.), Tel.; 5 p m., Dios. ; superficial, 
 extending to upper margin of concha, Mez. (r.) ; bald spot, Pho.; sensa- 
 tion of a BAND across, Am. br. ; BITING, itching, > scratching, Grat. (r.) ; 
 BORING, Cannab. i. (r.) ; burning, Apis (1.) ; COLDNESS, externally, spread- 
 ing in rays, Indg. ; like a stone, evening, Lac. ac. ; COMPRESSION, Hur. ; 
 during stool, Ox. ac. ; congestion, burrowing, Coc. c. (1.) ; constriction, 
 Lach., Murx. ; cutting. Garb. v. (1.) ; drawing, Asaf., Coloc. (r.), Mez. 
 (r.), Verat. (r.) ; in bed, Chel. (1.); in an old scar, Lach. (r.) ; extending to 
 crown, Lach. (r.) ; eruption, itching, scurfy, Stap.; fulness, Glo.; at noon, 
 Sarr., itching, > touch. 111. (1.); spreading over whole body, in morning, 
 Am. car. ; pain, Ced., Chel. (r.), ( < r.), Ger. (1.), Hur. (1.), Merc, sol., 
 Plumbg. ; in evening. Chin. s. (r.) ; 8 P.M., Dios.; acute, 9 P.M., Dios. (r.) ; 
 extending through upper back teeth, Chel. (1.) ; light, with numbness of jaw, 
 Hur.; pulsating, Lepi. (1.); pimples, red and itching. Cop.; PINCHING, 
 Garb. V. (].); pressure, Arg. (r.), Camph. (1.), Ced., Dul. (1.), Mez. (1.), 
 Nx.m. (r.) ; externally, Sabi. (r ) ; pulsation, Glo., Lepi. (1.); pustules, 
 containing serum, Sum. (1.) ; shooting, 6 p.m., Erio. (r.) ; soreness, on 
 touch. Lye. (1.) ; stiffness. Plan. ; stitches, Asaf. (r.), Mur. ac. (r.), Sep. ; 
 4PM., Merc. sol. (r.) ; when walking, Ars. ; acute, K. ca. ; dull, Mag. c ; 
 fine, Plan.; pressive, Coc. c. (1.); spreading in rays, externally, Lidg. ; 
 TEARING, Camph., Chel. (r.), Na. slfc. ; pressive, Arg. (1.); tension, in an 
 old scar, Lach. (r.) ; trembling, Arg.; twitching, Aga. m., K. ca. ; bone, 
 burning, aching, extending inward, Stap. (1.) ; drawing posteriorly, Mez. (r.) ; 
 pain, Bry. (1.); pressure, Pul. (r ); swollen sensation, Plan.; tearing. Led. 
 (r.), Merc; < touch, Aga. m. (r.) ; posteriorly, Led. (r.) ; tension, Coc. c. 
 
 Before External Ear. Aching, Anac. (1.), Cup., Dios., Merc. i. f., Na. m. ; 3 
 p.m., Dios. ; extending to angle of jaws, Dios. ; boil, with suppurating pain on 
 touch, Lau. (r.) ; BORING, Lau. ; on bending trunk to right, Mag. m. (1.); 
 bruised sensation, on touch, Zn. (r.) ; bubbling. Lye; burning, > rub- 
 bing, Grat. (1.); bursting sensation, Dios.; coldness externally, extending 
 like rays, Lidg. ; CRACK extending from left upper lip over cheek to ear, 
 Am. car. ; DULNESS, in evening, Cham. ; FULNESS, Glo., Lact. ; sensation of 
 something heavy, Carb. v. ; and in ears, with a stopped sensation. Garb. v. ; 
 heaviness, and in ears, with hard hearing. Garb. v. ; itching, Ol. an. ; > 
 scratching, Ol. an.; touch, 111. (1.) ; NUMBNESS, Sul.; PAIN, Dios. (r.), Der. 
 (<!.); 3 A.M., Dios.; 8 A.M., from cough, Dios. (r.) ; 11 a.m., Dios. (1.) ; 
 acute, morning, Dios. ; extending to ear, when raising hand to right side of 
 neck, Elap. ; papules, Na. c. ; pressure, Dios. ; inward, Sep. ; pulling, 
 Dios. ; PULSATION, morning, Lye. ; evening, Lye. ; after lying down. Hep. ; 
 on lying on ear, Bar. c. (1.) ; while standing after dinner. Castor, (r.) ; pus- 
 tule, Mag. c. ; SCREWED in sensation, Sul. ac. (1.) ; soreness, Senec. (1.); 
 on touch, Pte. (r.) ; squeezing sensation, extending to angles of jaw, Dios. ; 
 STIFFNESS, Plan. ; stitches, in evening. Ran. s. (r.) ; acute, Mag. m. (r.) ; 
 
224 EAR: EXTERNAL. — BEHIND, DRAWING. 
 
 5,30 P.M., Mag. c. (1.) ; burning, 2 p.m., Ol. an. (r.) ; cutting externally, Arg. 
 (1.) ; extending downward, Verb. (1.) ; into ear, Stro. (1.) ; fine, Lau. (1.), Mil. 
 (1.), Plan. ; spreading like rays externally, Indg. (r.) ; tearing, in evening, 
 Con.; SWELLING, Pte. (r.) ; boil-like, discharging, Bry. ; painful, like a boil, 
 on touch, Calc. c. (1.) ; TEARING, Bov. (r.), Mag. m., OL an. (1.), Stro. (r.), 
 Tab. (r.); 4 P.M., Mag. c. (1.); after dinner, Bov. (r.) ; acute, Na. p. (1.); 
 extending into cheek, Sul. ac. (1.) ; into temple, K.iod. (r.), (1.), Sul. ac. (1.) ; 
 external, Mag. m. (r.) ; piercing. Rat. (r.) ; twitching, externally. Tab. (r.) ; 
 TWISTING, II P.M., Dios.(l.) ; TWITCHING, Mag. m.; on moving head, Sul.ac. 
 (1.); tearing, Angu. (1.); ULCER, Carb. v.; discharging through ear when 
 touched, Merc. sol. (r.) ; sensation of an ulcer, in morning, Sars. (1.) ; vertigo 
 passing up to vertex like a wave, Sol. p. ; vesicles, painful and filled with pus, 
 Cic. V. ; sensation as if he would vomit, Dios. ; bones, boring, Aur.m. n. (1.), 
 Bar.c. (r.) ; construction, Zn. (r.) ; crawling. Bar. c. (r.) ; drawing, Bar.c. (r.) ; 
 gnawing, Sul. (1.), on swallowing, Sul. (i.) ; pressure, Aur, m. n. (r.) ; 
 swollen sensation. Plan.; tearing. Bar. c. (r.), Indg. (r.). Rat. (r.), Zn. (1.); 
 near eye, tearing, Grat. (1.); skin red, rough, tetter-like, with oozing and 
 bad smell from behmd the same ear, and sticking from the ear to the head, 
 Olnd. (1.). 
 Behind External Ear. Aching, Mos., Na. m. (1.), Stry., Thu. (1.), Vio. o. 
 (1.) ; on going into open air, > touch, Mang. (1.) ; on shaking head, Glo. ; ex- 
 tending to temples, Ced. (r.). 
 
 — Agreeable sensation on bathing in cold water, Fl. ac. 
 
 — Biting, Lye. (r.) ; > scratching, 01. an. 
 
 — Boil, Bry., Catts., Na. c, Phyt., Stap., Thu. (r.) ; tearing m, Angu. (r.) ; 
 
 boils and tumors. Con., Rum. c. 
 
 — Boring, Aur. (1.), Aur. m. n., Cannab. i. (r.), Caus., Caus. (1.), Coloc. (r.). 
 
 Cup., Mez. (r.), Mos., Rum. c. (1.), Saba.; evening. Ran. s. (r.) ; while 
 walking, Mez.; behind and in ear, Cup. 
 
 — Blisters, and on neck, small, burning, painful, in evening, sensitive to 
 
 pressure next morning. Am. car. (1.). 
 
 — Bruised sensation, Chel. (1.), Cic. v. (1.), (r.), Lachn. 
 
 — Burning, Aur., Na. m. (r.), Rhu. v., Thu. (r.), Saba.; 4 p.m., Grat. (r.) ; 
 
 night, Aur. m. ; in spot, Calc. ph. (r.). 
 
 — Cleft sensation, Am. car. (1.). 
 
 — Compression, < walking, > sitting, Asar. 
 
 — Contraction, Stry. 
 
 — Crack, Chel. (r.) ; in a downward direction, Chel. 
 
 — Cramp, Murx. ; on going into open air, > touch, Mang. (1.). 
 
 — Crawling, All. c. (r.). 
 
 — Crust, Aur. m. 
 
 — Cutting, Bell., Carb. v. (1.) ; extending down neck, 10.15 p.m., Ir. foe. 
 
 — Darting, Stry. (r.), Xan. (r.) ; evening, Dios. (1.) ; extending in front of ear 
 
 and to angle of jaw, morning, Dios. (1.). 
 
 — Drawing, Anac. (1.), Asaf. (1.), Coloc. (1.), K. bi., K. ca., Sul. (1.), Thu. 
 
 (r.) ; in bed, Chel. (1.) ; < touch, Sil. ; extending to lower jaw, Zn. (1.) ; to 
 mastoid process. Chin. 
 
 — Elevation on red base, with burning, stitching, and twitching, Ars. (r.) ; 
 
EAR: EXTERNAL. — BEHIND, ERUPTION. — PIMPLES. 225 
 
 small elevations, V^?cc. c, preceded by itching, and followed by soreness 
 after scratching, Mez. 
 Behind External Ear. Eruption, Ant. cr., Canth., Cast, eq., Cinch., 
 Guare., Jug. (r.), K. iod , Olnd., PitL, Saba., Sel., Stap. ; and on external 
 ear, Cinch., Cic.v., K. iod., Petrol., Pho., Pul., Sep., Sil., Spo., Siil. ; itch- 
 ing, Mag. s. (r.); after scratching, Mag. m. ; burning itching, < night, 
 Vio. t. ; Itching of an old eruption, Mag. m. ; resembling itch, in children, 
 Arun. ; moist, Calc. c; and on external ear, Calc. ostr. ; scabby eczema 
 with deafness, Pso. (r.) ; scurfy, Ant. s. (r.); and on external ear. Hep.; 
 humid, and scurfs on external, Pso. ; humid suppurating, and on external 
 ears, Lye; itching, Stap.; sore, Pso. (r.) ; red irregular spots, Cocc. 
 
 — Formication, Pry. 
 
 — Fulness, Thea. 
 
 — Gnawing, K. iod. 
 
 — Heat, dry, Merc, sol.; extending to vertex, Pso. 
 
 — Herpes, moist, Am. m. 
 
 — Irritation from pin or any thing. Plan. 
 
 — Itching, Aur., Calc. c, Calc. c. (1.), Carb. v., Fago., Grap., Hur., Mez., Na. 
 
 m., Na. m. (1.), (r.). Nit. ac. (1.), Rhodo (1.), Rhu. v. (r.), Til., Verat., Verat. 
 V. (r.) ; noon, Fago. ; evening in bed, Sul. (r.) ; night in bed, Merc. i. f. 
 (r.) ; < night, Aur. m. ; > rubbing, Zn. (1.) ; > scratching. Cans, (r.), Mag. 
 c. (r.), Mag. m. (1.), Rut. (1.); acute, Mez.; he wants to scratch the ears 
 off, Thu. ; EXTENDING to nape of neck, Rhodo. (1.); persistent. Lye; 
 as from tetter, Hur. 
 
 — Lumps, Bar. c, Dro., Grap., Pho. ac, Sars.; hard, Cinnb. (1.), and painful 
 
 to touch, Grap. (r.) ; sensation of, on turning head to left, Grap. 
 
 — Moisture, Aur., Grap., Lye, Petrol., Rhu. v. (r.) ; and sore places, Grap. 
 
 — Numbness, on pressing teeth together. Aloe. 
 
 — Oppression, Thea. 
 
 — Oozing and bad smell, with red, rough, tetter-like skin in front of ear, and 
 
 sticking from ear to head, Olnd. (1.). 
 
 — Pain, Arum. d. (r.), Calc. ph.-, C/ieL (r.). Castor. (1.), Glo. (1.), Hur. (r.), 
 
 Kalm., Myric. (1.), Pte. (r.), Thea.; 3 a.m., Dios. ; 8 A.M., Guan.; 11 A.M., 
 Dios. (1.); 3 p.m., Pte. (r.) ; 5 p.m., on waking, Pte. (r.) ; 6 p.m., Pte. (r.) ; 
 6.30 p.m., Yuc. (r.) ; 10 P.M., Pte. (r.) ; night, Merc. i. f. (1.) ; on press- 
 ure, Nice, (r.) ; > RAISING head, Ig. ; and in right side of NECK and 
 thigh, Kalm. (r.) ; in neck and cheek at night, Kalm. (r.) ; ACUTE, Glo., 
 Hur., Pte. (r.) ; morning, Dios. ; 9 A.M., Pte. (r.) ; deep-seated, Dios. (r.) ; 
 EXTENDING in front of ear and to angle of jaw in morning, Dios. (1.); 
 into ears,' All. c. ; down side of neck. Pic. ac. (r.) ; upward, Fl. ac. (r.) ; 
 upward and diagonally towards opposite ear and right parietal bone, Cer. 
 b. (1.); from deep in head, All. c. ; drawing from neck. Apis (1.) ; fine, 
 Dios. (1.) ; as from pressing on a SORE, and in ear and larynx. Lye. ; 
 wandering, Na. sic. (1.). 
 
 — Pecking, All. c. (r.). 
 
 — Pimples, Alum, (r.), Cala., Cale. (1.), Cans., Lye. (].), Nice, (r.), Na. m. 
 
 (1.), Pul. (1.), Saba, (r.), Sel., Sul. (r.), Sul. (1.) ; after scratching, Mez.; 
 bleeding easily, Opu. (1.) ; burning, on touch, Canth. (r.) ; hard, Grap. 
 
226 EAR: EXTERNAL. — BEHIND, PINCHING. 
 
 (r.); INFLAMED, Sul. (r.); ITCHING, Rhu. t, ; TAINFUL, Cannab. s. ; SORE, 
 Pal. (1.); on pressure, Grap. (r.), Ham.; on scratching, Mez. ; on touch, 
 Calc. p., Dro. (1.). 
 
 — Pinching, Garb. v. (1.), Paeo. (r ) ; 8 a.m., Guan. 
 
 — Pressure, Aeon., Asar. (1.), Bell., Bor., Cad., Canth. (r.), Caus., Cina., Coloc. 
 
 (1.), Hell., Led. (r.). Mane, Mez. (r.), Na. slfc. (1.), Nit. d. s.. Plat , Rut., 
 Stan., Thu., Verb., Vio. o. ; obliging him to bite teeth together, Crot. h. ; 
 as from a blunt instrument, Cannab. s. (r.) ; dragging, Merl.; dull, 
 evening on drinking rapidly, Na. m. ; as from a hard body, of the size of 
 an egg, Grap.; sudden. Verb. (r.). 
 
 — Pulling, K. ca., Merc. sol. (1.). 
 
 — Pulsation, All. c. (r.), Ami. n., Calc. p., Caus. (I.), Glo., K. ca., Mez. (r.), 
 
 Rhu. t. (1.); (agg.) moving head, K. ca.; warmth and lying on affected 
 side, Rhu. t. (1.) ; (amel.), cold air and walking, Rhu. t. (1.) ; extending 
 into eye. Pic. ac. ; hammering. Cap. 
 
 — Pustules, Phyt. ; in a circle. Cast. eq. (1.) ; containing serum, Sum. (1.). 
 
 — Rash, Ant. cr. ; gritting, itching, Na. m. 
 
 — Rawness, Petrol. 
 
 — Redness, Aeon. 1., Ant. s. (r.), Nit. ac. (1.), Petrol., Rhu. v.. Til. 
 
 — Scabs, Grap., Pul., Sil., Stap. ; exuding glutinous moisture, sore to touch, 
 
 Thu. (r.) ; herpetic, K. iod. 
 
 — Shooting, 6 p.m., Erio. (r.) ; inward, < warmth and lying on affected side, 
 
 >cold air and walking, Rhu. t. (1.). 
 
 — Soreness, Anac, Cic. v. (1.), Cup. ar., Grap., Petrol., K. ca.. Nit. ac, Pso., 
 
 Lye. (r.), Mur. ac. (r.), Sul., Verat. ; on touch, >scratching. Rut. (1.); as 
 from a blow, Cic. v., Verat.; humid, Petrol.; in a spot, Calc. p. (r.), 
 Gi-ap. ; to touch, Merc. sol. (1.). 
 
 — Stitches, .^th.. Am., Aur., Bell., Bro. (1.), Cannab. s. (r.), Canth., Cans., 
 
 Cent., Cilia, Con., Cop., Dig., Hell., Hep., Kalm., K. ca., K. n., Mag. c, 
 Meny., Nitr., Saba., Sabi., Sars., Tab. (1.), Tarax., Verat., Verb, (r.), Vio. 
 o., Vio. t. (1.); morning, Calc. c. (1.); afternoon, Pho. ac. ; evening, 
 Sul. (1.) ; I p.m., Na. c. (r.) ; during rest, Sabi. ; with stitches in ear, Am. 
 car.. Bell., Kalm. (r.); pinching in ears and with decrease of pain, Nitr. 
 (r.) ; reddish swelling. Tab. ; acute, Verat. (1.) ; biting, Bro. (1.) ; burning 
 crawling, Saba.; dull, Arn.; 3 p.m., > pressure, Mag. c. (r.); extend- 
 ing into jaws, K. n. (1.), Lye; stinging of insects, in a dream, Pho.; 
 itching, Vio. t. (1.) ; with reddish swelling. Tab. 
 
 — Swelling, Bar. c. (1.), Benz. ac. ; hard, red. Tab. (1.); painful to touch. 
 
 Cap.; reddish. Ant. s. (r.) ; with sticking. Tab. ; soft, painless, two inches 
 in diameter, like the swelling on a new-born child, above and behind ear, 
 one could feel beneath the swelling a sharp edge of bone. Bar. m. (r.). 
 
 — Tearing, Aga. m.. Alum., Ambra (1.), Am. car.. Am. car. (1.), Angu., Arg., 
 
 Arg. n. (1.), Bar. c. Bar. c. (r.). Bell., Camph., Canth., Cap. (1.), Chel. (r.), 
 Colch., K. ca., K. n., Lau., Lye. (1.), Mur. ac. (1.), Meny., Nitr., Phel., Pb., 
 Rhodo., Rhu. t. (1.), Sars., Sep., Sil. (r.), Squ., Squ. (1.), Tab. (r.) ; i p.m., 
 Na. c. ; 3 P.M., Phe.; 4 P.M., Caus. (1 ) ; 9 p.m., > sitting up in bed. Alum.; 
 < moving head, Am. car. (r.) ; drawing, Coc. c. (L); extending towards 
 nape, Mur. ac. ; to shoulder, Ars.; extending to vertex, occiput, nape. 
 
EAR: EXTERXAL. — BEHIND. — MASTOID PROCESS. 22/ 
 
 and shoulder, after dinner, < moving head, Am. car. ; up\\-ard, K. ca. ; after- 
 noon, Sars. (1.) ; fine, i p.m., Sil. ; and below ear, in afternoon, Sil. (r.). 
 Behind External Ear. Tension, Alum, (r.). Am. car., Apis (r,). Apis 
 (1.), Asar., Caus., Co7i., Daph., K. n., Mez. (1.), Nitr., Pb., Verb. ; < press- 
 ure, Glo. (r.) ; AND beneath ears, Apis ; extending from neck. Apis (1.) ; 
 upward, transient. Am. car. (r.) ; with sticking and tearing, Nitr. (r.). 
 
 — Tetter, Am. m. ; and tetter-like roughness, and below ear, Mar. ; scaling off 
 
 and improving, Grap. 
 
 — Thumping, Hell. f. (1). 
 
 — Tickling, Bro. ; > scratching, Bro. (r.). 
 
 — Tumor, suppurating, Phyt. 
 
 — Twisting, Am. m. (1.) ; extending to temples, Ced. (r.). 
 
 — Twitching, Am. m., Fl. ac. (1.), K. ca., Merc. sol. 
 
 — Vesicles, Calc. can., Chin., Xa. m. (1.), Pho , Pso. (r.), Rhu. v., Rhu. t. ; 
 
 filled with serum, Rhu. v. ; discharging turbid serum, Rhu. t. 
 
 — Wart-like growths inflame and ulcerate, Calc. c. 
 
 — Wen, existing from infancy, discharged, Merc. i. r. (r.). 
 
 — Bone, pain extending towards neck, Lith. (1.) ; periosteal swelling, Carb. a. 
 
 — Fossa, tearing, Carb. v. (r.). 
 
 — Glands swollen, Colch. (1.), Dig., Grap., Hur. (r.), Xab. (r.), Mt. ac, 
 
 Wies. ; sticking and tearing, extending through ear, at 6 p.m., > warmth 
 of bed. Nit. ac. ; tension, G7-ap. 
 
 — Hair matted, Chel. 
 
 — Mastoid Cells. Acute inflammation. Cap.; pain. Sap. (1.). 
 
 — Mastoid Process. Aching, yEth. (1.), Caus., Coca (r.). Con; before mid- 
 
 night, in warmth of bed, Coc. c. (1.) ; passing through to opposite side, 
 II A.M., while sitting. Erg. a.; special action, Glo.; affection, in scrofu- 
 lous individuals, after abuse of mercury. Hep. ; boring, Oni., Na. slfc. 
 (r.); bruised sensation, on pressure, 0'«(Z ; extending to clavicular and 
 pectoral regions, Coc. c. (1.) ; caries, Aur., Xit. ac. ; and of ossicula, with 
 discharge, Aur., Y\. ac. ; coldness, ^th. (r.) ; congestion, burrowing, 
 when worst, extending to clavicular region, lower back teeth, and side of 
 occiput, Coc. c. (1.) ; CONSTRICTION, as by a hot band, extending from one 
 to other across occiput, Coc. c. ; CUTTING, twitching, Sil. ; drawing, 
 Canth. (r.), Gent. c. ; in evening, 01. an.; extending backward, towards 
 noon. Aloe (r.) ; downward, Thu. (r.) ; >pressure, Arg. ; to lower teeth, 
 Mez. (r.) ; stinging, extending to left frontal protuberance, Sars. (r.) ; NUMB 
 sensation, as if head were screwed together, Plat.; pain, Bry. (1.), Chel.y 
 Lob. s., Physo., Phyt. (1.), Pte. (r.), Verat. v. (r. ); in morning, Ham.; 7 
 A.M., on waking, Trom. (1.) ; afternoon and evening, on first going out in 
 wind, Ham. ; erratic, Polyg. ; extending across occiput to over right ear, 
 Lac. ac. (1.); to shoulder, back of clavicle, at 9.30 a.m., Hydrs. (r.) ; to 
 scapula, Hydrs. (1.) ; as if a dull nail were forced into head, Olnd. ; pene- 
 trating, cramp-like, in morning, Sul. ; pulsating, Hur. ; afternoon, > warmth, 
 Ir. V. ; before midnight, in warmth of bed, Coc. c. (1.) ; suppurating, on 
 touch, Calc. c. (1.), Coc. c. (1.) ; peculiar sensation. Ham.; pinching, 
 periodical, as from pressure of a button, Thu. (r.) ; pressure, Bell., Hey. 
 ac, Lach., Nit. d. s. (1.) ; bruised, on pressure, Plat. (1.) ; as from a button. 
 
228 EAR: EXTERNAL. — MASTOID, ABOVE. — BENEATH. 
 
 Thu. (r.) ; drawing, Thu. ; extending to opposite side, 1 1 a.m., while sit- 
 ting, Ery. a.; outward, K. bi. (1.) ; tensive, Coc. c, Coc. c. (1.) ; extending 
 to clavicle and lower back teeth, < lying on ear, Coc. c. (1.) ; towards each 
 other, in morning, Sabi. ; sensation. Ham. ; shooting. Plan. ; when 
 walking in wind, Ham.; with tearing, Canth. ; outward, Calc. p.; sore- 
 ness, Brach., Ham. (r.) ; extending half-way down jaw, on moving jaw, Ir. 
 v.; stitches, Aga. m. (1.), Canth. (r.), Con., Euphr. (r.), Pie. (r.), Ter. 
 (r.), Thu., Thu. (r.); acute, coarse, Cannab. s. ; drawing. Bar. ac. (1.) ; 
 dull, Cham, (r.) ; extending to anterior part of neck, morning, on rising, 
 < motion, Na. m. (r.); intermitting, acute, Caus. (r.) ; swelling, with 
 redness, boring pain, and feeling of obstruction in the ear, sometimes 
 going off with a report, Sil. ; painful, with inflammation, Merc; sore to 
 touch, Cap.; sensation of swelling, Calc. c. (1.) ; tearing, Arg. (1.), Berb. 
 (1.), Calc. cau. (r.), Canth. (r.), hidg. (1.), Mang. (r.), Sep. (r.). Ton. (r.) ; 
 with shooting, Canth. ; drawing in evening, Thu. (1.) ; extending into 
 lobule of ear, Canth. (r.) ; upward, Rat. (1.) ; as with a knife, Canth. (r ) ; 
 sticking, Meny. ; twitching, Rhu. v. (r.) ; tension, cramp-like, Sul. (r.) ; 
 dull, < after pressure, Gio. (r.) ; thrusts, Bell.; tingling, in afternoon, 
 > warmth, Ir. v.; twitching, Kre. 
 External Ear. Above mastoid process, pressive drawing, Chel. (1.) ; pain 
 in evening, Chin. s. (r.) ; pulsating, Kre. (1.). 
 
 — Behind mastoid process, aching. Aeon, (r.); as if stiff at 12.40 p.m., 
 
 Equ. (1.); PAIN, acute, extending outward in evening, Ost. ; extending 
 backward and upward, Cer. b. (1.) ; to upper part of orbit, < after sleep, 
 Na. hy. (r.); tingling. All, c. (1.); STITCHES, Vio. (r.) ; 7 to 8 P.M., Lye. 
 
 — Below mastoid process, bruised sensation, Rut.; drawing, in evening, 
 
 Thu. (r.) ; > pressure. Dig. ; cramp-like, Sul. (r.) ; node, burning, pulsat- 
 ing, Eupi. (1.); pain, 9 a.m., on pressure, Glo. (1.); redness, afternoon, 
 Fago. ; stitches, like pinching, Cina ; tension, in evening, Thu. (r.) ; 
 at 4 p.m., Bry. 
 
 — Muscles of mastoid process, cramp, drawing, Mang. (1.); drawing, 
 
 Lau.; sprained, extending to clavicle, Petrol. ; pain. Bell.; tearing, ex- 
 tending to clavicle. Petrol.; tension, cramp-like, during day, Sul. 
 
 — Periosteum of mastoid process, stitches, after 7 p.m., Carb. a. (r.) ; 
 
 swelling, Guare. ; after 7 P.M., Carb. a. (r.). 
 
 — Petrous portion of mastoid process, swollen, red, and painful, Cap. 
 
 — Posteriorly in mastoid process, pressive, cutting, and suppurating pain, 
 
 on touch, Mur. ac. 
 
 — Region of mastoid Process, tumors or boils, Con. 
 
 — Root of mastoid process, dull stitches, > touch, Sars. (r.). 
 
 — Meatus, on level with, lancinations, 10.30 p.m., Ir. foe. (r.). 
 
 — Neck, on. Pain, Cham. (1.), Rap. ; pulsative, Angu. ; pimples, easily bleed- 
 
 ing, Opu. (1.) ; tearing pressure, lod. (r.) ; twitching stitches, evening, 
 Stap. ; tension. Apis. 
 
 — Skin, swelling, Rhu. v.; tension, Con.; spasmodic, extending obliquely 
 
 into nape. Lye. 
 
 — Soft parts, pressure, Led. (r.). 
 
 Beneath external ear. Aching, Colch., Opu.; bruised sensation on 
 
EAR. EXTERXAL. — BEXEATIL 229 
 
 touch, Zn. (r.) ; burning, 10 a.m., Rut. (1.); coldness, Cer. s. ; conges- 
 tion, burrowing, Coc. c. (1.) ; contraction, cramp-like, extending to ramus 
 of lower jaw, Dul. (1.) ; cracking, Chel. (1.); crawling, Verat.; darting, 
 Xan. (r.) ; drawing, Sul. ac. (r.) ; outward, cramp-like, Olnd. ; eruption 
 discharging water, Pte. (r.) ; dry scaly, Mar. (r.) ; FURUNCLE, with tension in 
 joint of jaw when chewing, Calc. ostr. ; ITCHING, Ars. (r.), Caus., Verat.; 
 > scratching, Mag. c. (r.), 01. an. (r.) ; biting, Verat.; lancination, Tarent. 
 (1.); PAIN, Aeon, (r.), Cap., Chel. (r.), Opu. ; when swallowing, Na. hy. (r.) ; 
 PAPULES, Ars. (r.), Euph. a. (r.) ; itching, Mag. c. ; PRESSURE, Arum ni., 
 Asar. (1.) ; inward, Sep.; pulsation, Sang.; irregular. Sang.; rents, Olnd., 
 a single rent, Chel. ; afternoon, > after pressing, Sul. ; shooting, 6 p.m., 
 Erio. (r.) ; has to cry out, Bar. c. (r.); smarting, burning, during menses, Mag. 
 c. (1.) ; soreness, Colch., Na. hy. (r.) ; stitches. Apis (1.), Crot. t., Mag. s. (1.) ; 
 deep, each alternately, Vio. o. (<1.); pressive, Coc. c. (1.); suppuration, 
 painful, Na. hy. (r.) ; swelling, Berb. (r.) ; extending up head, Na. hy. (r.) ; 
 hard, painful, < pressure. All. c. (1.); great swelling, heat, redness, and a 
 lump, with sharp pain, restless at night, with improvement of hearing, Sam. 
 (r.); TEARING, Ol. an. (r.), Pho. (r.) ; while sitting, > rubbing, Pho. ; extend- 
 ing sometimes to vertex, occiput, nape, and shoulder, after dinner, < moving 
 head, Am. car ; fine, and below, i p.m., Sil. (r.) ; transient at 4 p.m., Caus. 
 (1.); and behind upward, violent, towards the helix, after five minutes it 
 goes slowly towards the left shoulder, then into nape of neck, and finally 
 into the occiput. Am. car. (1.); tension, Apis, Apis (r.), Spig. (1.); and 
 behind. Apis ; tetters and tetter-like roughness, and behind, Mar. ; thread 
 tied around, sensation of, Rum. c. ; thumping. Hell. f. (1.) ; tickling, Sang. ; 
 vesicles, Pte. (r.); bones, pressing construction, Zn. (r.) ; carotids, pul- 
 sation, Verat. (1.) ; FOSSA, boring and bruised pain on pressure, Caus. (r.) ; 
 tearing pressure, lod. (r.); GLANDS, inflammation, Sars. (r.) ; soreness, Pte. 
 (r.) ; extending into middle of posterior cervical region, < evening, Cinnb. 
 (r.) ; on touch. Bar. c. (r.); swelling. Bar. c. (r.), Pte. (r.), Sars.; hard. Am. 
 car.; near JAW, burrowing, Lach. (1.); stitch, Bar. c. (r.) ; tearing and pain 
 on toucli, Colch. (r.). 
 
230 EAR: MIDDLE. — ABSCESS. — HEAT. 
 
 MIDDLE EAR. 
 
 Middle Ear. Abscess would form, sensation as if, with heat and a stitch, Bry. 
 
 Aching, Cane. f. (r.), (Chin.), Saba.; in day, Stach. (1.) ; on swallowing, Dro., 
 Fago. (1.). 
 
 Air penetrates on blowing nose, Pul., Sul. ; on drawing jaw to other side, 
 Sarr. (r.) ; cold air rushes in during eructations, Caus. ; passing out of cold, 
 as when laughing, Mil. (1.). 
 
 Boring, with burning in throat, Ol. an.; obstructed feeling, sometimes going 
 off with a report, and swelling and redness of the mastoid process, Sil. ; 
 outward, Euphr. (r.). 
 
 Bubbling, Con., Dul. (1.), Euphr., K. ca., K. n.. Petrol., Rhe., Sil. (r.); on 
 stooping, Grap. ; as of air, Hur. (1.), Lye, Na. m. (1.) ; deep-seated, Lim. 
 
 Burning, Angu.; as from a coal, Tep. (r.) ; painful, on swallowing, Haem. 
 
 Bursting sensation, when eating, or swallowing saliva, Pso. ; as of bubbles, 
 Carb. v., Grap., Na. m. (r.) ; of a membrane, then buzzing, Gam.; painful, 
 from the throat towards the ear, All. c. 
 
 Catarrh, purulent, Vesp. 
 
 Closed sensation, on blowing nose, Mar. (r.) ; from within, when swallow- 
 ing, Ars. 
 
 Contraction, in evening, Spig. 
 
 Cramp, in evening, and in external ear, Ran. b. (1.); like ear-ache and com- 
 pression, in evening, Thu. 
 
 Crackling, < chewing, Alum. 
 
 Crushing, when swallowing, Calc. c. 
 
 Cutting, K. iod. 
 
 Darting, acute. Ton. (r,). 
 
 Distension, painful sensation of, Til.; as if it would burst, or as if some- 
 thing struck the drum, Sil. 
 
 Drawing, Angu. (r.), Pho. ac. (r.); durmg eructations, Sul. (1.); on swal- 
 lowing, Fer. ma. ; as if ears would burst. Hell.; extending into Eusta- 
 chian tube, after dinner. Ant. c. (r.) ; shooting drawing together, on 
 swallowing, Dro. ; spasmodic, at night on swallowing, Alum. 
 
 Dryness, Colch. 
 
 Fluttering, Aga. m. (r.) ; as if opening and shutting, in right, then left, then 
 both at same time, > putting in finger, Ir. foe. 
 
 Forced in, feeling as if something were, Lye. 
 
 Fulness, in evening, Na. p. ; after stitches leave it, Iod.; from swallowing. 
 Arum d. ; with heat, at i p.m., Com. 
 
 Heat, Arum d. (1., then r.), Bry., Calc. c; morning in bed, Cocc. (r.) ; from 
 
EA R : MI DDL E. — I NFL A MM A TION. — SORENESS. 2 3 I 
 
 swALLOWiNCx, Arun. ; with heat in external ear, Calc. p., Case. ; morning 
 in bed, (Coco.); fulness, i p.m., Com.; inflammation of external ear, red- 
 ness and swelling, Pul. ; stitch and sensation as if an abscess would form, 
 Bry. ; like hot blood, Calc. c. 
 
 Inflammation, Aeon., Chin., Cocc, K. ca., Merc. sol. ; with inflammation 
 of external ear, Bell., Calc. ostr., Merc, and discharge of pus. Bell, (r.), 
 and redness and swelling, Pul. ; discharge, Carb. v. ; stinging and tearing, 
 Merc. 
 
 Itching, Dios., Spira. ; evening, Elap.; 10.30 p.m., Dios. (r.), (1.); when 
 swallowing, Sil. ; with crawling, when swallowing, and itching in throat, 
 K. ca., Sum. ; desire to swallow, Nx. v. ; inclination to lessen it by swallow- 
 ing, Carb. V. 
 
 Obstructed feeling, sometimes going off with a report, with boring pain 
 in ear, and redness and swelling of mastoid process, Sil. 
 
 Opening through which air could^ penetrate, sensation of, on opening and 
 closing mouth, with thrust-like stitches from right side of fauces suddenly 
 extending into ear, Thu. (r.). 
 
 Opening and shutting sensation, 6.45 p.m., Jr. foe. 
 
 Pain, Apis (r.). Arum d. (r.). Coca (r.), Ig., Physo. (r.); afternoon and 
 evening, Sul. (r.); afternoon and during eructations, Tarent. (r.) ; on 
 swallowing, with ulcers, Bov. (r.); swallowing saliva, Pb. ; on touching 
 external ear, Tab.; WITH contracted feeling in throat, Haem.; warmth, cold- 
 ness of right concha and burning heat of left, which extended beyond the 
 temple, in evening, Na. n. ; extending from throat, Lith. ; a painful spot 
 in throat, Lob. i. ; to ear, when swallowing, Lach. (I.). 
 
 Pinching, Am. car., Carl. (1.); with acute thrusts, .5"^//. y extending towards 
 drum, Dul. (1.) ; into pharynx, Carb. a. (1.). 
 
 Pressure, Calc. cau., Physo. (r.) ; on sneezing or swallowing, Sul.; as 
 from a blow, on stooping, Cham.; as if it would burst, Rhu. t. ; with 
 stitches. Lye; intermittp:nt, Arn.; inward. Nit. ac. (1.), Tarax. (1.) ; 
 outward, Na. slfc. m. ; on loud reading. Coca; on swallowing, Nx. v.; 
 sticking, Calc. cau. (1.); as if every thing would be pressed together, 
 almost cramp-like, Dro. (r.) ; like TWINGING, Grap. 
 
 Pulsation, Nit. ac, Sil. (r.). 
 
 Rattling, Aga. m. (r.). 
 
 Relaxed sensation, with hard hearing, < violent swallowing, Rhe. (r.). 
 
 Rolling, with twitching, Aga. m. (r.). 
 
 Shocks, or twinging, waking from sleep, Merc. d. (1.). 
 
 Shooting, Bell.; during eructations. Bell.; shooting from ear, < swal- 
 lowing, Con.; with pain in throat, K. ca. ; extending into palate, K. bi. ; 
 stinging, Tarent. 
 
 Something before, Calc. a.; sensation of, on blowing nose hard, > swallow- 
 ing, Calc. c. 
 
 Soreness, Cup. ar. (r ); in afternoon, Dios. (1.). 
 
 Soreness, dull, in r. internal ear. Cup. ar., both ears are internally sore and 
 denuded., the right worse, Merc. sol. 
 
 Soreness of /. internal ear, in p.m., Dios.; both ears sore to touch internally, 
 8 p.m., Dios. 
 
232 EAR : MIDDLE, — STABBING. — EUSTA CHI AN TUBE. 
 
 Stabbing, Physo. 
 
 Stitches, Bry., Cane. f. (r.), Ran. b. (r.), Rhodo., Tanac, Thu. (r.) ; when 
 BLOWING NOSE, Hep., Lyc. ; when drinking, Com. ; during swallowing, 
 Na. m. (r.); empty swallowing, Thu.; with stitches in larynx when swal- 
 lowing, Mang. ; inflammation and tearing, Merc. ; warmth in ear, and sensa- 
 tion as if an abscess would form, Bry. ; COLD, Aga. m. (1.) ; cutting, extending 
 to brain, Arg. (1.); drawing. Aloe (1., then r.); extending outward, Sep.; 
 through external ear, Thu. (r.); inward, Arn. ; fine, Dro. (1); itching, 
 PtiL ; lightning-like, in evening, Thu.; picking, with burning of ex- 
 ternal ear, Cle. ; scraping, Mang. ; tearing, alternating with same in other 
 parts of head, Berb.; thrust-like, sudden, coming from right side of 
 fauces, with sensation, on opening and closing mouth, as if there were an 
 opening in ear, which air could penetrate, Thu. (r.). 
 
 Stopped sensation, Glo. ; morning on rising, > blowing nose, Stan. (1.). 
 
 Swelling, with discharge. Cist. ; inflammation of middle and external ear, 
 redness and heat, Pul. 
 
 Tearing, Ars., Berb., Caus., Chel., Pho. ac. ; afternoon, when sitting, Indg.; 
 evening, Merl. ; with tearing in external ear, Mag. m.. Rat., and in car- 
 tilage, K. ca.; stinging and inflammation, Merc; tearing in right side of 
 head, on raising head after stooping, Ant. t. (r.) ; asunder. Con.; extend- 
 ing downward, and in external ear. Bell. ; fine, Cyc. (1.) ; suppurative, 
 < boring in, Anac. 
 
 Thrusts, with pinching. Bell. 
 
 Tickling, PuI. ; extending into Eustachian tube, Na. p. ; crawling, Mang. 
 
 Twinging, Drq. (1.) ; and in external ear, Asar. ; or shocks, waking from sleep, 
 Merc. d. (1.). ' 
 
 Twitching, Am. car., Lyc. ; on blowing nose, and on sneezing, Act. ; and 
 in external ear. Dig. ; with rolling, Aga. m. (r.) ; EXTENDING to shoulder, 
 Cannab. s. (r.); tearing, Angu. (r.). 
 
 Ulcerated sensation, on swallowing, S:d. 
 
 Eustachian Tube. Aching before dinner, < turning head to right and on swal- 
 lowing, > warm soup, Coc. c. (r.); affection, Lyc; air catches itself, 
 as in a sac, on taking a pinch of snuff, and on eructation of wind, Tel. (1.) ; 
 prickling burning, <swallowing, Aeon. ; catarrh, Calc, Con., Gel., Grap., 
 lod. ; with stitch-like pain and tearing in ear, and redness and swelling in 
 meatus, Pul.; cutting on chewing, Arg.; drawing, Pul. n. (r.) ; after din- 
 ner. Ant. c (r.) ; DRYNESS, Stram. (r.); flapping, as if air were forced 
 through, on every eructation, Grap. ; GURGLING as from air, Caus., Grap. ; 
 inflammation, Ery. a. ; irritation, Phyt. ; itching, Caus., Nx. v. ; sen- 
 sation of MUCUS in. Cot. (1.); obstruction, Hydrs., Phyt. (1.); pain, Cot. 
 (1.), Lach., Ox. ac. ; acute, to submaxillary gland, 8 P.M., Fago. (r.) ; as from 
 a rough body (on change of weather) before the setting in of wind or rain, 
 Nx. m.; stitches, Aga. m. (r.), Carl., Menth. pu. (1.); extending within 
 ear, on swallowing, Sal. ac. (r.) ; itching, extending to ear, < boring with 
 finger, Coloc; stinging, Tarent. ; twitching to drum, > boring with finger, 
 Carl.; stuffing sensation, Aeon, (r.); running of wax, Crot. h., Lach.; in 
 OPENING IN EAR, pain now and then, in afternoon, Ox. ac (<r.j; at pha- 
 
EAR: MIDDLE. — MUSCLE, OSSICULA. 233 
 
 RYNGEAL ORIFICE, itching crawling to drum, Arg. (r., then 1.) ; tickling itch- 
 ing, extending into tympanum, alternating with ringing in left ear, Aga. m. 
 (r.); pain in afternoon. Ox. ac. (<r.); in region of, chilling or burning 
 twitching, then above it a sort of gnawing, both painless. All. c. (r.) ; vol- 
 uptuous, extending through inner ear to mouth, Coc. c. 
 
 Muscle, tensor tympani, jumping, Aga. m. (r.). 
 
 OssicuLA, caries, and of mastoid process, with discharge, Aur., Fl. ac. ; caries 
 with inflammation. Lye, Sil., Sul.; destruction and discharge of, Asaf., Aur., 
 Hep., Nit. ac, Sil. 
 
234 EAX: INTERNAL. — HEARING, ACUTE. 
 
 INTERNAL EAR. 
 
 Internal Ear. Hearing Acute (includes Sensitive, Irritated), Aeon., 
 Aga. m., Alco., Alum., Ambra, Am. car.. Am, mur., Anac, Angu., Ant. 
 cr.. Apis, Arn., Ars., Ars. hydr., Asaf., Asar., Aur., Ear. c, Bell., Bor., 
 Bry., Cact., Cala., Calc. c., Calc. ostr., Camph., Cannab. i., Canth., Cap., 
 Carb. a., Carb. v.. Cans., Ced., Cham., Chel., Cic. v., Cic. v. (1.), Cina, 
 Cinch., Cocc, Coff., Colch., Coloc., Con., Cup., Dig., Fl. ae.. Gam., 
 Grap., Hell., Hep., Hydrphb., Hyos., Hype., Ign., lod., Ip., K. ca., K. hy- 
 dro., Lach., Lau., Lye, Mand., Mag. c, Mag. m.. Mar. (r.), Merc, Mos , 
 Mur. ac, Narcot., Na. c, Na. slfc, Nit. ac. Nit. ox., Nx. m., Nx. v., Olnd., 
 Ol. an.. Op., Ox. ac, Petrol., Pb., Pho., Pho. ac, Physo., Phyt., Phyt. (<r.). 
 Plan., Plat,, Pub, Saba., Sabi., Sang., Sars., Sec. c, Sel., Seneg., Sep., Scu., 
 SiL., Spig., Squ., Stan., Stap., Stram., Stry., Sul., Tab., Ther., Thu., Val., 
 Verat., Vio. o., Zn., Zing.; morning, Fl. ac, Rhodo. ; even.ng, Calc a.. 
 Coca, Grap., Rhodo.; on falling asleep, Calc a.; night, Bry., Carb. v., 
 Atro. ; after waving in head and cracking in ear, Grap.; when lying, 
 Grap.; during menses. Hype.; hears everything in slumber, Alumn., Ars., 
 Grat., Na. m.. Op., Sul.; in partial slumber, Euphr. ; and retains a clear 
 consciousness of his condition in a sort of slumber, Mor. ; on waking, Carb. 
 v., Pul.; on WALKING, Lye; >open air. Tab. 
 — Sensitive, with impaired hearing, Am. car., Arn., Lye, Merc, Plat., Sul., 
 and anxiety, Pul., SiL; crawling in ears, Lach.; roaring. Aeon. ; ringing of 
 slightest tone, wakes with rush of blood to head, haii: standing on end, 
 anxiousness and shuddering, formication from the slightest motion in bed, 
 Carb. v.; illusions. Cap., Cup., 01. an.; great affection of mind, Zn. ; 
 desire to be alone. Con., and at rest. Bell.; anger, Ip. ; anxiety, Aur., 
 Cap., Pul., SiL; hatred of company. Bell, Pho.; bitter complaints, Ign.; 
 irritability. Bell., Calc, Con., Hype., K. ca., Nx. v., Pho. ; whining and 
 crying, Crot. h., Lach. ; headache, Anac, Apis, Bar. c. Bell., Calc ostr.. 
 Con., Ig., lod., Merc, Nit. ac, Pho. ac, Spi<^., Stan. ; contracting. Aeon. ; 
 shooting, Cic. v.; tearing, Lach., Spig.; dizziness, Ther. ; bursting, Spig.; 
 irritability of head. Bar. c, Calc. ostr.. Nit. ac, Pho. ; stunning, through 
 brain, Stan.; rush of blood to head, PuL; desire to shut eyes. Con.; 
 shunning of light, Con.; enlarged pupils, Ign.; toothache, Calc. ostr., 
 Ther.; NAUSEA, Nx. v., Sul., Ther.; crackling noise in ABDOMEN, Merc. ; 
 DiARRHCEA, Cocc, Nit. ac, Nx. V. ; leucorrhcea, Carb. v. ; cough, Arn., 
 Pho. ac. ; convulsions, Nx v.; tetanic spasms, Cic v.; tetanus, Cas- 
 tor., Nx. V. ; aggravation of pains, Arn., Ign., lod.; reserved man- 
 ner, Con.; acuteness of all senses, Coff.; soreness all over, Coloc, 
 
EAR: INTERNAL. — HEARING, ACUTE. — MUSIC. 235 
 
 Mag. m., Nx. v. ; starting, Narcot., Na. car., Saba., K. hydro., Con., Sil., 
 I^Iag. car. ; with shock through the whole body, Ther. ; frightened, Ant. 
 cr., Calc. ostr., Calc, Cannab. s., Card, b., Con., Hype., Na. car., Saba.; 
 when the door is opened, Mos. ; starting up from the sofa with his whole 
 body, Carb. v.; with shuddering, Carb. v.; out of sleep, Angu., Apis; 
 whistling sound through every LIMB, Grap. ; with torpor. Op.; with 
 COLD STAGE, Am., Cap. ; horripilation. Sang.; heat. Con. 
 Sensitive hearing. Alternating with dull, Anac. 
 
 — Bells, causing stinging in ears, Pho. ac. ; church-bell is doleful, and moves 
 
 to tears. Ant. cr. 
 
 — Carriages, rattling of, Nit. ac. ; during deafness for voice, Chen. a. 
 
 — Cocks crowing, causing headache, nausea, and vertigo, Ther. 
 
 — Clocks striking and cocks crowing at a distance keep her awake, Lye. 
 
 — Hammer-stroke in a neighboring smithy, every, Sang. 
 
 — Laughing, Mang 
 
 — Minute sounds, Phyt. 
 
 — Music (including Music Unbearable), Acon., Arabra, Am. car., Anac, Ant. 
 
 cr., Bry., Calc. ostr., Carb. a., Carb. v.. Cans., Cham., Coca, Coff., Croc, Dig.^ 
 Grap., Ign., K. ca., Kre., Lye, Mang., Merl., Na. c, Na. slfc, Nx. v., 
 01. an., PJio., Pho. ac, PiiL, Rhodo., Saba., Sabi., Sars., Seneg , Sep., 
 Sil., Spo., Stan., Stap., Stict., Sul., Tab., Then, Thu.^ Vio. o.^ Zn.; even 
 in the deaf, Sul. ; tunes which he had formerly liked, Seneg.; aversion 
 to music. Aeon., Carb. v., Cham., Na. c, Nx. v., Pho., Pho. ac, Sabi., 
 Sep., and every thing, Merc; especially to the violin, Vio. o. ; with 
 peevishness and irritability, Cans. ; seeks solitude, darkness, a'nd silence, 
 Nx. V. ; cannot bear it in the head, Pho. ; nervousness so great that it 
 goes through bone and marrow, Sabi. ; when merry. Croc. ; causing de- 
 jection, and increase of fearful presentiments. Dig. ; irritability, Mang., 
 Na. slfc, Sabi. ; melancholy. Aeon., Na. slfc. ; sadness, Aeon., Dig. ; sor- 
 row, Na. slfc. ; inclination to weep. Ant. cr., Grap., Kre., Nx. v., Thu., 
 < in evening, Grap., and other uncommon emotions, Kre.; inclination to 
 weep from even lively music, Na. slfc. ; a single note sets him to singing. 
 Croc; causes headache, Ambra, Pho, Ther.; < headache, Ign.; causes 
 congestion of blood to head, Ambra; vertigo, Ther.; weakness of head, 
 Pho.; pressure on occiput, Sabi.; stinging pains in ears, Pho. ac. Tab., 
 and drawing sensation in cheeks and teeth, Pho. ac. ; trembling sensation 
 in ears, Saba. ; aggravation of toothache, Calc ostr. ; a single note causes 
 nose-bleed, Hep.; music causes nausea, Sul., Ther.; cough, Ambra, Calc 
 ostr., Cham., K. ca., Kre., Pho. ac; a single note causes cough, Stan.; 
 music causes painful anxiety in chest, Na. c ; aggravation of symptoms 
 of disturbed circulation. Aeon., Calc. c. Dig,, Lye, Nat., Nx. v., Pho. ac, 
 Sep., Stap., Thu., Vio. o. ; palpitation, Stap.; orgasms, Ambra; drawing 
 in upper limbs, Merl.; complaints, Calc ostr., K. ca., Vio. o. ; uncommon 
 and agreeable sensations, Ig. ; trembling, Na. c, Na. slfc, in evening, 
 Sabi.; trembling and weariness, must lie down, Na. c; weakness, Na. 
 slfc, Nx. v., Sabi., Sep.; a single note causes exhaustion, Nx. v.; made 
 sick by dull hearing of music, Sul.; music makes her drowsy, and shuts 
 the eyes, a clairvoyant dream, Stan. ; sweat, > open air, Sabi. ; dancing 
 
236 EAR: INTERNAL. — HEARING, ACUTE. — NOISES. 
 
 MUSIC causes dreams, Mag. s. ; merry tune is softly repeated when 
 vexed, Croc.; the organ fatigues. Lye. ; piano playing is intolerable, 
 Na. car., Na. slfc, Pho., Sep.; complaints from, Anac, Calc. ostr., K. ca., 
 Merl., Na. c, Na. slfc, Nit. ac, Sep., Zn. ; causes weakness of head, 
 Pho. ; nausea, Sul. ; fatigue, Sep., with painful anxiety in chest, Na. c ; 
 trembling and convulsions, Na. slfc. ; SAD music mollifies ill-humor, 
 Mang. ; makes him lively, the most lively does not exhilarate, Mang. ; 
 sensitive to singing, Am. car., Pho. ac, Sars., Stan., Spo. ; aversion to 
 hearing singing. Lye; singing causes exhaustion, Nx. v.; in a church, 
 palpitation, Carb. a.; can play only the SOFTEST tones, Coff. ; abhorrence 
 of the violin, Vio. o. 
 
 — Noises (including Noises Unbearable), Agon., Alum , Al. p. s., Am. car., 
 
 Anac, Angii., Ant. cr.. Apis, Ar7i., Ars., Aur., Bar. c, Bell, Bar., Bry., 
 Cala., Calc. c, Calc. ostr., Camph., Cannab. i.. Cap., Carb. a., Carb. v., 
 Card, m.. Cans., Chavi., Chel., Cic v., Cina, Cinch., Cocc, Coff., Coloc, 
 Con., Crot. h., Cu?., Dig., Fl. ac. Gam., Grap., Hell., Hype., Hur., Ign., 
 lod., Ip., K. ca., K. hydr., Kre., Lach., Lyc., Mag. r., Mag, m.. Mane, 
 Mang., Merc, Mos., Mur. ac, Narcot., iVa. c, Na. m., Na. slfc. Nit. ac, 
 Nx. m., Nx. v., Olnd., Ol. an., Op., Ox. ac, Petrol., Pho., Pho. ac.. Plat., 
 Pb., Pte., Pill., Saba., Sang., Sel., Sep., Scu., Sil., Spig., Stan., Stram., 
 Sul., Tab., Ther., Xan., Z//. ; with hard hearing, Merc, and dreamy, 
 dull state of mind, Zn. ; roaring. Aeon. ; anger after contradiction, Cocc , 
 anger and rage, Ip. ; anxiety, Aur., Cap., Cans., Na. c, Pul., Sil. ; full of 
 care, Aur., Bar. c. ; difBcult comprehension. Cap.; cross, all things dis- 
 agree, Pho. ; displeased with every thing, nothing is right, Ars. ; fretful- 
 ness, Ars. ; ill-humor, Bell., Pho.; illusions, at night, Carb. v. ; irritation 
 and faint-heartedness, Cinch. ; unreasonable lamentations, bitter com- 
 plaints, Ign.; reserved mania. Con.; men are offensive, Pho., melancholy, 
 a little noise startles much, Stram.; morose and peevish, K. ca. ; peevish, 
 irritable, Pte.; stupefaction, Lach.; suspicious, as if his life were con- 
 spired against, Al. p. s. ; vexation, Rhu. t., and anger, Mang. ; weeping, 
 ^th., Kre. ; causing heat, Bry., Caus., Coff., Sep. ; distress, with otitis, 
 Merc; tingling, Lach.; every noise, as filing, scratching, scraping 
 with the feet, causes shuddering, which penetrates the teeth and causes 
 trembling, Rhodi., Sul.; LOUD, Calc. ostr., Cap., Cup., lod., Ol. an., Pho., 
 Sil., Spig, Tab., Ther.; anxiety when among the noise of many people. 
 Petrol. ; every sound or shrill noise penetrates the whole body, especially 
 the teeth, causes vertigo, which produces nausea, Ther. ; slightest noise, 
 Angu., Ant. cr., Ars., iod., Coloc, Calc ostr., Cannab. s., Carb. v., Card, 
 b., Cic. v.. Con., Ip., Narcot., N. c, Nx. v., Op., Pho. ac. Plat., Saba., 
 Sel., Tab., Ther.; in sleep, Ars. hydr., Cala., Op., Pho., Sel.; causing 
 crying and weeping, Lach. ; full of fears with every noise in the street, 
 Caus.; sudden, Phyt., Sang. 
 
 — Organ. See under Music. 
 
 — Painful, Cocc, Con., Lyc, Sang., Seneg., Sil., Spig. 
 
 — Paper, folding of, Cala. 
 
 — Piano. See under Music. 
 
 — Reading, loud, Verben. 
 
EAR: INTERXAL. — HEARIXG, ACUTE. — ALTERED. 23/ 
 
 Sensitive hearing. Sharp sounds, Cop. 
 
 — Singing. See under Music. 
 
 — Step, every, Coff. ; cannot bear to hear walking in the room, with extreme 
 
 moroseness and nausea, Sang. 
 
 — Sudden, with looseness of bowels, Bell., Bor. 
 
 — Talking of others, Ambra, Am. car.. Am., Ars., Aur., Ear. c, Calc. ostr., 
 
 Carb. v., Cinch., Cocc, Colch., Con., Ign., lod., K. ca., Mag. mur., Mang., 
 Mar., Xx. v., Pho , Pho. ac, Rhu. t., Sil., Spig., Stap., SuL, Ther., Ter. 
 m. m., Verat., Verb , Zn., Zn. o. ; causing excitement and irritability, Am. 
 car., and trembling through whole body, Ambra, Calc. c. ; sensation as if 
 losing consciousness, K. ca. ; dulness, Stap. ; fright and shooting in head, 
 Cic. V. ; confusion of ideas from the increased headache, Aur, ; increased 
 headache, Aur., Cocc, lod., Pho. ac. ; ailing in one half of head, Ign.; 
 ailing in forehead, Sil.; rush of blood to head, Coff.; shaking of brain, 
 Con.; sore feeling in brain, Cinch.; vertigo, Cham.; dull gtitches in ear, 
 Mang. ; heat in face, Sep. ; complaints, Sil. ; increase of pains, Arn., Ars., 
 Mag. m., SuL, Ther., Zn. o. ; weeping when spoken to, Stap. ; aversion 
 to, lod., Pho. ac, Zn. ; at a distance, making him nervous, and causing 
 headache, Mur. ac. ; LOUD, Carb. v., Coff. t., Pho., Pte. ; causing pain as 
 if the head would burst, lod.; dizzy headache as if bursting, loud, strong, 
 causing drowsiness in head, Spig. ; of MEN, causing headache, Bar. c. ; her 
 OWN, Up. 
 
 — Violin. See under Music. 
 
 — Walking. See Step. 
 
 — Water poured out or running, if he hears, or if he sees it, he becomes very 
 
 irritable or nervous, it causes desire for stool, and other ailments, Ily- 
 droph. ; if the hydrant runs in his room his nervous headache becomes 
 unbearable, Hydrophb. 
 
 — Whip, crack of, (SuL). 
 
 Altered, during coition, Grap.; when lying, Ant. cr., Agn., Aur., Con., 
 Cro., Grap., Hep., Mag. c, Merc, Xa. m., Pho., Pho. ac, Plat., PuL, Rhodo., 
 Rhu. t., SuL, Thu., Val. ; lying on affected side. Am. car.. Bar. c, Euphr., 
 Sep., Sil.; lying on back, X^a. c; when moving head, X"a. c, PuL, Stap.; 
 resting head on table, Fer. ; when scratching head, Am. car.; at REST, Stap.; 
 rising and sitting up, Euphm., Grap., X'^a. c, Sep., Verat.; when sneezing. 
 Bar. ac, Euphm.; on standing, Am. m, Ars., Bell., Con., X"a. m., SuL; 
 during painful, bloody stools, K. clc ; when talking aloud, Mar., Pho., 
 Spig ; on walking, Aga. m.. Bar. c, Bell., Benz. ac, Carb. a., CheL, Mang., 
 X'icc, Rhu. t., Spig. ; WHISTLING, Rhodo. ; > sitting up. Am. car. ; with 
 a shock as of a cannon. Bad.; vertigo, Aeon., Bell., Carb. v.. Sang.; wiih 
 vibration in head, Sil. ; with ringing in head, Ars. ; with flow of blood to 
 head, roaring and humming, Sang., SuL ; headache, Glo., Plat. ; in temples, 
 Cinch. ; with shaking of head, K. ca ; constipation, Alum. ; pain in limbs, 
 Ars. ; cold feet, Thu. 
 
 Another, as with ears of, Pso. 
 
 Confused, Alco., Carb. a., Equ. (L), (< 1.) ; does not know from what direc- 
 tion sounds come, Carb. a. 
 
 Distant, sounds seem, Cham., Eth., Sol. n. ; on turning upper part of body 
 
238 EAR: INTERNAL. — HEARING, ECHOING, IMPAIRED. 
 
 from right to left, Eupi.; voices seem, Coca; on waking, Nit. ox.; from 
 unconsciousness, Nit. ox. ; his own voice, Cannab. i. 
 
 Echoing. See Reverberating. 
 
 Illusions, Abs., Alco., Atro., Carbn. ox., Carbn. s., Conin., Elap., Eup. pur., 
 Hyos., K, br., Stram., Thea. ; during sleep. Aeon. 1.; with ringing, Val. 
 
 Impaired (includes Difficult, Hard, Dull, etc.). Aeon., ^th. (< 1.), Aga. 
 m., Agn., Alco., All. c, Alum., Ambra, Am. car.. Am. m., Anac, Anac, 
 (1.), Angu.,Ant. cr., Apis, Agr., Arg. n., Arg., n. (1.), Am., Ars., Asaf., Asar. 
 (< r.), Ast., Ast. (< r.), Aur., Aur. m., Aur. s., Bap., Bar. c. Bell, Bor. (1.), 
 Bov., Bry., Bry. (1.), Cad., Calc. c, Calc. ostr., Calc. ostr, followed by 
 Lye, Calc. p., Cannab. i., Canth., Cap., Carb. a., Carb. v., Carbn. 0., Carbn. 
 s., Caus., Cham., CheL, Chel. (1.), Chin., Chin, s., Cle., Cic. v., Cic. v. (1.), 
 Cinch., Cist., Cocc, Cocc. (r.), Coc. c, Coc. c. (1.), Coff., Colch., Coloc, 
 Com., Con., Conin., Cori. r.. Croc, Cup. ac, Cyc, Cyc. (r.), Der., Dig., Dro., 
 Did., Euphrb., Eth., Fer., Gad., Gam., Gel., Glo., Grap., Guara., Hal., Hep., 
 Hydrs., Hey. ac, Hyos., lb., lb. (r.), Ig., Ip., loD., lodf., Jat., Kalm , K. CA., 
 K. br., K. iod., Kre., Lack., Lachn., Lau, Led., Lyc, Mag. c, Mag. m., 
 Mag. m. (1.), Mang., Meny., Merc, Merc. i. r., Merc, sol., Merc. sol. (r.), 
 Mez., Mos., Mur. ac, Na. ar., Na. C, Na. c. (1.), Na. m., Nice, Nico., Nitr., 
 Nit. AC, Nit. ac. followed by Petrol,, Nx. m., Nx. v., Olnd., Op., Op. (1.), 
 Par., Petrol , Petrol, followed by Nit. ac, Pho. ac, Pho., Physo. (r.), Phyt., 
 Plat., Pb., Pul., Pul. n.. Ran. b., Rke., Rhode, Rhu. t.. Rut., Saba., Sabi. 
 Sal. ac. Sang., Sars., Sec c , Sel., Sep., Sil., Spig., Spo., Squ., Stan., Stap., 
 Stram., Sul., Sul. (r., then 1.), Sid. ac, Tab., Tarax., Tarent., Tel., Tep., Ther., 
 Thu., Thu. (r.), Val., Verat., Verb., Vio. o., Wies., Zn.; morning, Calc. c, 
 Cle., Gam., Merc. i. r. ; forenoon, Asaf. ; 7.30 a.m., Cle.; 11 a.m., Mag. c. 
 (r.) ; till 8 p.m., Physo.; afternoon, Elap., Sil.; evening, K. ca. ; 4.30 p.m., 
 Mag. c. (1.); 9 p.m., Physo. (r.) ; night, Ced. ; in bruised ear, Jac. (1.), 
 Lach. (1.); after otorrhoea, Bor.; after pain. Nit. ac. ; after burning and 
 stinging, Cap.; after blowing nose. Con.; after taking cold, Bry., Pul.; 
 after cutting hand, Bell., Pul.; after a concussion, fall, firing of gun or 
 cannon, Arn. ; after dinner, Sul. (1.); while eating, Sul.; on mental exer- 
 tion. Con.; after measles, Merc, Pul.; checked measles, Pul., Merc; 
 during menses, Mag. m.; in old people, Petrol., Verat.; after abuse of 
 quinine, checked intermittents, Calc. ostr.. Sec c; when reading aloud, 
 Coca, Verben. ; in rheumatic or gouty diathesis, Petrol., Rhodo. ; after 
 SCARLET fever, Lyc, Nit. ac, Sul. ; in scrofulous subjects, Calc. i., Lyc. ; 
 after singing, Apoc. c (1.), Ars., Pho.; after checked foot sweat, a warm 
 sand-bath for the feet and Baryt., Sil., or Sec c internally ; after typhoid 
 fever, Arn., Pho. ; after waking, Sep., Zn. ; (agg.) eating, Sil. ; in house, 
 Mag. c (r.) ; noise, 01. an., Plat., Tab. ; stillness. Ant. cr. ; change of weather, 
 Mang.; (amel.), 10 a.m., after being out, Merc. i. r. ; after dinner. Gam.; 
 driving in a carriage, Grap.; after a crash in ear, Grap., Mur. ac, Sil.; for 
 a moment only, Mang. ; after noises, Arn., Mur. ac. ; after rushing, Lach., 
 and roaring, galvanism, Lach. ; after spattering, Spig. ; when snapping is 
 felt, Tarent. ; on blowing nose, Meny. ; on swallowing, Merc. ; after getting 
 warm from walking, Merc i. r. ; dashing on cold water, Glo. 
 — With buzzing in ear, Bov., Petrol., Mag. c; humming, Cact., Dro., Iod., 
 
EAR: INTERNAL. — HEARING IMPAIRED. 239 
 
 Nice, Sec. c. ; and whizzing, Lye, Merc; catarrhal affection, Calc. 
 ostr., Con., Gel., Fer., Grap., lod., Pul. ; digging, Jac. ; discharge. Am. 
 m., Asaf., Calc. ostr., Carb. v., Caus., Elap., Lye, Merc, Sil., Tel. ; of pus, 
 Asaf., Bor., Pul., at times, Sul., fetid, Asaf., Aur., Bo\.; drawing pain, 
 Lach. ; sensation as if drum were relaxed, Rhe. ; dryness, Grap., Mur. 
 ac. ; of outer ear. Petrol.; sensation of something falling before ear, 
 Cocc. (r.) ; FLUTTERING, Mag. c, Spig. ; hammering, Croc, Pso., Sil.; 
 HEAT and burning in and about the ear, Jac ; of external ears, Mur. ac. ; 
 heaviness in and before the ears, Carb. v. ; habitual herpetic eruption 
 in meatus, Grap. ; hissing, Dig. ; humming, Nice, Sec. c ; itching in 
 ear, Bov. ; and suppuration, .(4 w. f«r., Bov. ; lancination. Con.; sensa- 
 tion of something lying before ear, Mag. m., Sul. ac. ; noises, Chin., 
 Coca, Merc, Pid. ; and digging pain extending to nostril, Jac. ; musical 
 noise, fear of apoplexy, great noise in the ear, distraction and loss of 
 memory, Cannab. ; numb sensation about ear (after Sul.), Lach.; otitis, 
 Merc, Thu. ; pain, Asar., Ig., and chilliness. Bell., Cham., Merc, Pul. ; 
 pain and ill humor, Nx. v. ; aching pressing, Ip. ; ringing, Arg. n., Grap., 
 Led., Pho., Pso.; fluttering. Bell., Mag. c, Rhe.; roaring, Aur., Bor., 
 Croc, Pho., Sil., Thu.; rushing, Calc ostr.; naise like a sea-shell 
 (after Sul.), Lach.; sensitiveness to noise, Merc; sound. Am, car., Arn., 
 Lye, Meic, Plat., Sul.; singing, Pso.; snuffing (in children), Kre. ; 
 loud sounding, Merc. ; spattering noise, Plat.; stinging, Am, mur.; 
 stoppage, Ars., Asar. (1.)., Calc. ostr., Coc c. Con., Gel., Grap., Hydrs,, 
 lod,, Lach., Nit. ac, Phyt., Pul., Sil,, Spig., Sul. ; swelling, > removing 
 wax, Calc. ostr.; throbbing, Hep.; tingling, Sul.; large ulcers, Led.; 
 black wax, Pul.; dry (after Sul.), Lach., Nit. ac. ; hard, Sel. ; increased, 
 Mur, ac, Zn. o. ; like chewed paper, Con,; whizzing, Mag. c; sound of 
 wind. Plat. ; imperfect activity, alternating with absence of mind, Alum.; 
 anxiety and sensitiveness to noise, Sil., Pul.; hypochondriac humor, con- 
 fusion of mind, Agn., Bap., Carb. a.; insanity, sensitiveness only after 
 loud screaming, half conscious, Ars. ; dull dreamy state, Zn. ; want of 
 memory, Mos. ; mistakes in speaking, Bov.; headache. Bar. m., Chin,, 
 Sul. ; stitches in head, Crot. t. (r.) ; heavy pressure and heat on vertex, 
 extending to both ears, with soreness of brain, Sul. ; old look to face, 
 Kre.; numb sensation down to the cheek, Lach.; wedge-shaped teeth, 
 Kre. ; swelling and induration of the tonsils, Merc, Nit. ac, Stap., after 
 abuse of mercury. Nit. ac, Stap. ; burning in stomach. Bar. m. ; hunger 
 daily at 11 a.m., Lach.; attacks of vomiting, Kre.; constipation, Sul.; 
 tetters, Dul., Fer., Nice ; trembling, Pul. ; faint feeling at 10, 11 a.m., 
 Sul. ; typhoid fever, Apis, Ars., Bell., Bry,, Carb. v., Hyos., Lachn,, 
 Lach., Merc, Nit. d, s., Pho., Pho. ac , Pso., Pul., Sec c, Stram., Sul.; hot 
 stage, Lachn,, Rhu. t. ; hot flushes in face followed by cold sweat, Sul, ; 
 burning of soles at night, Sul.; cold stage, Cham., Cinch., Pul., Rhu, t. ; 
 sweat on back, Pul. 
 Impaired. Alternating with acute, Anac; with noises, Anac. ; eye symp- 
 toms, Guare. 
 
 — Closed. See Plugged. 
 
 — Distant sounds, for, Pho. 
 
240 EAR: INTERNAL. — FALLING. — LOST. 
 
 Impaired. Falling before the ear, as if, Calc. ostr., Nit. ac, Sul.; falling 
 into the ear, Con. 
 
 — Hand were held over ear, as if, Chel. 
 
 — Impression, hears every thing but it makes no, Hell. 
 . — Intermittent, Sil. 
 
 — Intoxication, as in slight. Op.; does not answer questions, Mag. c. 
 
 — Leaf, lying before, as if, Ant. cr., Sul. ac. 
 
 — Lying before, as if something were, Aeon., Agn., Asar., Bell., Carb. cr„ 
 
 Cannab. s., Carb. v.. Cinch., Cocc, Coloc, Cyc, Hyos., Led., Mag. m., 
 Meny., Par., Pho., Rhe., Rhu. t., Saba., Spig., Sul. ac, Verb. 
 
 — Mist, like a. Par. 
 
 — Noise, as through a great, 01. an. 
 
 — Opened wide and hollow, as if ear were, Con. 
 
 — Part, hears a, Mang., Spig. 
 
 — Periodical, Spig.; every other day, Pho., Pul. ; every week, Sul. 
 
 — Plugged (includes Closed, Obstructed, etc.), as if. Aeon., ^///., Agn., 
 
 Am. car., Anac, Angu., Ant. cr., Arg., Aj-g. ji., Ars., Asar., Bell., Bism., 
 Bor., Bry., Cala., Calc. ostr., Cannab. s, Carb. v., Caus., Cham., Chel., 
 Cinch., Cocc, Colch., Coloc, Con., Cyc, Gel., Grap., Guai., Hyos., Jac, 
 \oV)., K. ca.. Lack., Lachn., Led., Lyc, Mag. m.. Mane, MM^iG., Merc, 
 Meny., Merc, Mez., Na. c. Nit. ac, Nx. m.. Par., Petrol., Pho., Phyt., 
 Pul, Rhe., Rhu. t.. Rum. c, Saba., Sel., Sep., Sil., Spig., Spo., Stan., 
 Sul., Sul. ac, Syph., Tel., Verat., Verb. ; with ringing, Mez. ; roaring, 
 Grap., Merc, Seneg., Sep. ; sensation as if ear-wax were running into 
 mouth, Lach. 
 
 — Skin were stretched over ear, as if, Asar., with ringing and roaring, Can- 
 
 nab. s. 
 
 — Sudden, Con., Dig., Gel., Nice, Pb. 
 
 — Voice, for human, Mur. ac, Pho., 6"//., Sul., Sul. (1.); especially for the 
 
 human voice, Mur. ac, Pho., Rhu. t., Sil., Sul.; for his own voice. Coca, 
 Pho. ; for every thing except human voice, Ars., Ign. ; with sensation of 
 wind in ear, Ign. 
 ■ — Water rushing, as from, Cocc. 
 
 — Watch, for, Pho. ac. 
 Irritation of. See Acute. 
 
 Lost (including Deafness), Aeon., ^th., Aga. m. (1.), Aloe, Alum., Ambra, 
 Am. car., Am. cau., Am. m., Amyg., Anac, Angu., Ant. cr., Ant. t., 
 Apoc, Arg., Arg. n.. Am., Ars., Asaf., Askk., Azir., Anr. m., Bap., Bar. c. 
 Bar. m.y Bell., Bon., Bor., Bov., Bry., Bnrsa par., Cact., Calc. ostr., 
 Cannab. i., Cap., Carbn. s., Carbn. s. (1.), Carb. v., Carl., Caus., Cham., 
 Chel., Chin, s.. Chin. s. (1.), Cinch., Cist., Coca, Com., Con., Cot. (1.), 
 Croc, c, Crot. h.. Cup., Cup. ac, Cyc, Dig., Z>;'^., DuL., Elap., Eth., Eup. 
 pur.. Gas., Gel., Glo., Grap., Hydrs., Hyos., Ig., Ip., lod., Jat., K. ar., 
 K. ca., K. n., Kre., Lach., Lau., Led., Lepi., Lepi. (1.), Lol., Lon., Lyc, 
 Mag. c, Mag. m., Mang., Meny., Merc, Merc, c, Merc, m., Mur. ac, 
 N'a. c, Na. m., Na. sal., Nice, N'itr., Nit. ac, Nx. m., Ol. an., Olnd., Op., 
 Petrol., Pho., Pho. ac, Phyt., Pb., Pul., Pul. n.. Rap., Rhodo., Rhu. t., 
 Rhu. v., Rut., Saba., Sain., Sal. ac, Sec c, Sel., Sep., Sil., Spig., Stan., 
 
EAR: INTERNAL. — LOST. — SUBJECTIVE SOUNDS. 24I 
 
 Stap., Strain., SuL., Sul. ac, Tel., Verat., (Verat. v.), Verb., Vip , Zn.; 
 MORNING, after rising, Stan. (1.); 10 A.M., during vibration in head, Grat. ; 
 AFTERNOON, Sil. ; 8 P.M., Nicc. ; after convulsions, Sec. c. ; after rough 
 COUGH, Led.; during dinner, SuL, and afterwards, Carbn. s. (1.); after 
 HICCOUGH, Bell. ; during menses, Lye. ; on blowing nose, Spig. ; after 
 roaring, Sep.; on waking, Oena. ; (agg.) evening, Bell.; 9 p.m., on 
 lying down, Merc. c. ; (amel.) boring in finger, Spig.; blowing nose, 
 Stan. (1.); riding in a wagon, Grap. ; during sensitiveness to sounds 
 of vehicles, Chen, a.; with, howling. Con., Kre., Sil.; itching and fetid 
 discharge, Bov. ; itching and suppuration. Am. car.; sensation of a leaflet 
 before ear. Ant. cr. (r.) ; pain, Bry., Cyc. ; ringing, Arg. n., Chin, s., Con., 
 Sul.; shooting. Bell.; sensation of something placed before ears. Bell., 
 Led.; stopped sensation, Cala., Mang., Peti. (r.), Sep., Spig. (1.); scabby 
 eczema behind ear, Pso. (r.); sensation of wind in ears, Cocc. (r.). 
 
 Deaf and Dumb. Calc. ostr., Sep., Sil., Sul. ; stupefaction, Am., Carb. a., 
 Crot. h., Kre., 01. an., Stram. ; dull headache, great anxiety, trembling and 
 sweating. Chin. s. ; buzzing in head, Pso.; vertigo, Crot. h. ; catarrh, Lach.; 
 congestion of blood. Bell. ; eructations. Petrol. ; anxiety in abdomen. Aloe ; 
 pain in abdomen, Crot. t. ; cough, Chel.; as if some one HELD HAND over 
 the ear, when coughing, Chel. (r.) ; as if ear were wide open internally and 
 hollow, after rmging in ear, Aur. m. ; sudden, Scr. ; with stopped sensa- 
 tion, when walking, Cic. v.; temporary, as if something had fallen into the 
 ear, with lancinating pains, principally coming on after blowing the nose, 
 Chin., Con.; THREATENING, Olnd., Pul. ; SENSATION of, Bar. c, Coca; 
 < lying on ear, Coc. c. (1.). 
 
 Low TONES of music incorrect, Bry. 
 
 Reverberating (including Echoing, Re-echoing, and Resounding), Alum., 
 Bar. c, Carb. an., Cans., Eth., Grap., lod., Mag. m, Merc, Merc, sol.. Nit. 
 AC, Nx. v., Pho., Pho. AC, Pul., Rhodo., Spig , Ther. ; morning. Cans., 
 Chin. s. (r.). Lye. (r.), Pho. ; on blowing nose, Bar. c. ; < morning, Caus. ; 
 eating, or after it, Nx. v.; > walking, Cop.; long, of strong tones, 
 Rhodo.; of music, Nx. v., Pho. ac, Pul., Spig.; of steps, Caus.; strong, 
 Nx. v. ; of WORDS, Caus., G3.S., T/io. ; in morning, > after dinner, Nx. v. ; 
 on waking, Pul.; of every word and every step, with hard hearing, Caus.; 
 of his own voice. Nit. ac. ; his own and others, m morning, Pho. ; of his own, 
 and it sounds like dumb-bells, Spig.; ascending by octaves, > after break- 
 fast. Ant. cr. 
 
 Sensitive. See Acute. 
 
 Vibrating of every sound, Pho. ac. ; of loud speaking, Pho. ; violent, or the 
 sounds go through the ear, with hard hearing, Merc. 
 
 Voices sound like a humming, Bell.; his own voice sounds like dumb-bells, 
 and resounds through the head, Spig. ; strange, his own seems. Alum., 
 Alum, (r.). Rum. c ; with sounding and humming in left ear as of a sea- 
 shell, cannot tell where the person is who speaks unless he sees him, from 
 the right to left ear talking loud is very painful, Terb. m. m. ; whispering. 
 Nit. ox. 
 
 Watch sounds like a hissing, Pho. ac. 
 
 Internal Ear. Subjective Sounds, Am. car. (1.), Ars., Benz. n., Meny. 
 
242 EAR: INTERNAL. — AIR. — BUZZING. 
 
 (r.), Sep.^ Spig. ; in FORENOON, >boring with finger, Castor.; with vertigo, 
 Sang. ; penetrating whole body, with a sensation of a wind in ear, Ther. 
 
 Air, escaped from ear, as if cold, when laughing. Mil. 
 
 Arteries beating, cerebral. Op. 
 
 Bagpipe, distant, when lying on side, > rising, Na. c. 
 
 Bang(NG, Bar. c, Na. c, Nit. ac, Saba., Zn. 
 
 Bat, Mil. (1.) ; at night, Pho. ac. 
 
 Beating, Alum., Am. car.. Am. m.. Bar. c, Berb., Bro., Calc. ostr., Carb. v., 
 Caus., Cinch., Coloc, Con., Ign., K. ca.. Lye, Na. c, Na. w., Nice, Petrol., 
 Pho., Rhodo., Sang., Sul. ; with buzzing. Nit. ac. ; clapping, Na. m. ; hum- 
 ming, Mur. ac, Nit. ac; distant, > rising, Mez. (1.) ; as if against a DOOR, 
 Ant. cr. ; pulse-like. Bar. c, Caus., Coca, Coloc, Dig., Glo., Grap., Lach., 
 Mag. m., Merc, Merc, c, Sep., Sil., Sul. ac, Zn. 
 
 Bed, as if some one were under the, Bell., with a rattling noise, Canth. ; over, 
 Calc. ostr. 
 
 Bells (compare wn"th ringing, tinkling, and tolling). Am. car., 
 Arun., Gas., Hyos., Led., Na. slfc. (r.), Pho. ac ; lo P.M., Val.; when walk- 
 ing, Chin. s. (r.) ; while yawning, Mez. (r.) ; < night, lying down, Sil.; 
 CHURCH, with mania, anguish, and anxious sweat, Ars. ; clear, Sul. ac. (r.) ; 
 distant, Coff. t., Der. p., Na. slfc. (1.); middle-toned. Coca. 
 
 Blood streaming through brain, Con., Op. ; rushing to brain, with a dull 
 noise, at every beat of heart. Op. 
 
 Blowing, Hydrc, Ox. ac. ; whizzing, Chel. ; then ringing, Na. m. 
 
 Bouncing, rattling, confused fallmg of hard things, Sep. 
 
 Bubbling, Con., Dul., Lye, Mag. c ; with coldness and dryness of ear, Berb. ; 
 dulness of sensorium. Plat.; before ear, morning after waking. Bell.; as 
 of something FALLING before and then away from, on becoming erect, and 
 leaning back, Grap. ; as of a liquid, Thu. (r.). 
 
 Bursting, like a bubble, Grap., Lye, Sul. ; then buzzing, Carb. b. ; as of 
 something fallen upon floor, Saba. ; as if something were falling to and fro, 
 Saba. 
 
 Buzzing, Aeon., Alco., Aloe, Alum., Am. car., Arg. ;?., Arn., Bell., Cact., Cai., 
 Calc. ostr , Canch., Cannab. i., Canth.., Carbn. s., Carl., Caits., Chel., Chen., 
 a., Chin, s., Coff., Con., Cop., Dro., Elap., Elap. (r.). Gam., Glo., Grap., 
 Hey. ac, Hydrphb., Hyos., lod., Ir. v., K. iod., Kalm., Lye, Mag. c (r.), 
 Mag. m., Mane, Mere, Murx., Nice, Nit.ac, Nx. m., Nx. v.. Pic. ac, Pho , 
 Pso. (1.), Rhode, Ric, Saba., Spig., Sul., Sul. ac, Sul. iod., Tarent., Thu. 
 (r.) ; in MORNING, Dios. ; forenoon, < whistling, Rhodo. (1.) ; noon, Ced., 
 Fago. ; AFTERNOON and EVENING, < after sensation of a leaflet bursting. 
 Gam. ; evening, i5'(??^ c; 2.30 P.M., > 4 P.M., Murx. ; 7 P.M., Physo. ; 10 P.M., 
 Ham.; when DESCENDING STAIRS, Crot. c ; on swallowing, Rhodo.; < 
 sitting, > LYING, STANDING, and WALKING, Bell. ; < BURSTING of a bubble, 
 Carb. b. ; WITH hard hearing, Bov., Mag. c, Petrol., and whizzing, Lye, 
 Merc. ; growling, after roaring. Bell. ; humming and illusions, Mag. m. ; 
 itching and roaring, Sep.; inflammation. Mere; dry earwax, Pho.; difficult 
 comprehension, Ars. ; stupor, Pso., and dulness, Lach. ; followed by cluck- 
 ins;, Aga. m. ; like BEES, FLIES, Am. car.. Con., Elap., Mag. c. Nit. m., Nx. v., 
 Sal. ac. ; before ears, Am. car., l^ar. c, Mag. m., Sol. n. ; fine, with head- 
 
EA R : INTERNAL. — B UZZING. — CRA CKLING. 243 
 
 ache, Glo. (1.) ; humming, Carb. ac. ; with hard hearing, Cact, Dro., lod., 
 Nice., Sec. c. ; rushing, on stooping, Mang. 
 
 Call, sudden waking from a, Ars. 
 
 Cannonading, Bad., Chel., Mos. (r.) ; then a few drops of blood come out, 
 Mos. 
 
 Cascade, Rhu. t. 
 
 Cat spitting, in afternoon, Nit. ac. 
 
 Chirping, Rat., Rat. (r.) ; at night, Mur. ac. ; like crickets, Carb. v., Caus., 
 Euphm., Euphm. (r.), Fer., Meny., Nice, Nice. (1.), Sil.; before ears, Fer. ; 
 like a grasshopper, Carb. v., Nx. v., Tarax., Tarax. (1.) ; like locusts, at 
 night, Nx. V. 
 
 Clanging, Sil., Spig. ; like a musical, monotonous, melancholy song of the 
 water-toad in Gei-many, Mang. 
 
 Clapping, Grap., K. ca., Na. c, Rhu. t., Saba., Sil., Stap., Zn. ; with cracks, 
 fright and starting, Rhu. t. ; knocking, Pho. 
 
 Clicking, spasmodic, opening and shutting (like closing or opening the fist), 
 very annoying, Nitr. 
 
 Clinking, while scratching occiput. Am. n. (1.). 
 
 Clipping, Grap. (r.). 
 
 Clock, Ter. ; in morning, Mang. 
 
 Clucking, Aga. m. (r.), Bar. c. Cad. s., Grap., Lye, Petrol., Rhe., Sil.; after 
 buzzing, Aga. m. ; on stooping, Grap. ; rising from stooping, Sep. ; with 
 noise as if something were falling to and fro, Grap. ; heaviness of head, 
 Grap. 
 
 Confused, Carbn. o., Fago., Hydrc. (1.), Par. 
 
 Cracking, Bar. c, Calc. c. (1.), Cocc, Ery. a. (1.), Grap., K. ca.. Each, (r.), 
 Mos., Na. m., Na. m. (1.), Nit. ac, Nx. v., Ol. an.. Petrol., Saba, Sang, (r.), 
 Stry., Sul., Tarent. (r.), Thu. ; in morning, Na. c. (r.) ; in bed, on moving 
 jaw, Grap.; evening. Petrol.; when eating, Grap.; 2 P.M., when eating, 
 Ped. ; after BREAKFAST, Zn. ; when chewing, Calc. c, Calc. ostr., Mang., 
 Meny., Na. m.. Nit. ac, Sil. ; blowing nose, Bry., Hep. ; when coughing, 
 Nx. v. ; moving head, Grap. (r.), Fnl. ; reading aloud. Aloe ; on sneez- 
 ing, Bar. c, Bry., Meny. ; stroking cheek with finger-tips, (Sang.) (r.) , on 
 swallowing. Bar. c, Calc. ostr., Cic. v. (r.), Coca, Coc. c. (1.), Der., E/ap., 
 Grap. (1.), Mang., Na. m. (1.), Sil.; on walking fast, Bar. c. ; with open- 
 ing of the ear, Mar., Mur. ac. ; claps, fright and starting, Rhu. t. ; pinching, 
 Na. c. ; swashing, on swallowing, Grap. ; before ear. Each. ; intermittent, 
 Petrol. ; low, flat, sliding, Grap. 
 
 Crackling (includes Crepitation), Alum., (Ambra), Aur., Aur. (1.), Bar. c, 
 Bor. (].), Calc. c, Calc. ostr., Coc. c. (r.), Uul., Dul. (1.), Eup. per., Eup. 
 pur., Glo., Glo. (1.), Grap., K. ca., Each., Eachn., Mos. (r.). Nit. ac, Rhe., 
 Saba., Sep., Spig.; evening while sitting, Hip. (1.); blowing nose. Bar. c 
 Calc. ostr., Mar. (r.); eating, Calc. ostr., Grap., K. ca., Mang., Meny., Na. 
 m.. Nit. ac, Ped. (r.), Sil.; when lying upon ear. Bar. c (1., then r.) ; on 
 swallowing, Alum., Bar. c, Calc. ostr.. Flap., Eup. pur., Mang.; on 
 walking, Nit. ac. ; with an indescribable unpleasant sensation, Mos. ; pain, 
 on eating, Na. m. ; before ears, as from rattling of paper, Sep.; as from 
 electric sparks. Hep. ; extending into forehead, > holding hand over 
 eye, Spig. ; as from STRAW, on every motion of jaw, Carb. v. 
 
244 ^^^ ■' INTERNAL. — CRASHING. — GURGLING. 
 
 Crashing, Bar. c, Cic. v., Cocc, Grap., Hep., Rhu. t., Saba.; to p.m., Con. 
 (r.) ; night, Bar. c. ; in BED, Grap.; on moving jaw, CHEWING, eating, Calc. 
 ostr., Grap., K. ca., Mang., Meny., Na. m., Sil.; when blowing nose, 
 Mang. ; when reading aloud, Aloe ; when sneezing. Bar. c, Meny. ; 
 when SWALLOWING, Bar. c, Coc. c, Meny.; when walking fast. Bar. c; 
 WITH pain, Na. m.; amelioration of hard hearing, Grap.; as from breaking 
 a pane of glass, on falling asleep, Zn. ; like a distant shot. Am. car., Chel., 
 Plat. 
 
 Creaking, Grap., Pul., Stan., Thu.; evening, Stan. (1.); on blowing nose, 
 hawking, etc., Bry. ; when swallowing, Aga. m., Grap. (1.), Thu. ; when 
 lying on affected side, with pulsation in ear, and pimples and pustules in 
 external ear, Spo. ; before ear, in evening, Stan. (1.) ; as from frogs, while 
 sitting, Mag, s. (1.) ; when walking, Mang. 
 
 Crepitation. See Crackling. 
 
 Crying aloud in a dream, hears himself. Bell. 
 
 Cymbals and drums, Lol. 
 
 Detonation, Cic. v. (r.), Itu., Mos. (r.), Grap. (1.); on blowing nose, Hep.; 
 on swallowing. Bar. c. Bar. m., Cic. v. ; like shocks, as of a cannon. Bad., 
 Mos. 
 
 Drum would burst, Rhu. t. ; had burst, during siesta, Rhu. t. (1.); as if some- 
 thing struck, Sil. 
 
 Drumming, Bell., Canth., Cup., Dul., Dul. (1.), Lach. ; on walking, Mane; 
 with sounds of cymbals, Lol., and trumpets, followed by roaring, Bell.; 
 distant, Dro. ; when lying on ear, > rising, Cup. ; dull, Bor. (1.) ; kettle- 
 drums. Bell. ; as on the top of a vaulted roof, Bor. 
 
 Dull (dead), opening with, after a closed sensation. Mar. 
 
 Explosion as from the breaking of glass, after getting into bed. Aloe. 
 
 Flapping, regular, Sil. ; like the wings of a large bird, Mos., Olnd., Plat., 
 Spig. ; with a discharge at every step as if a valve were opened and shut, 
 Grap. 
 
 Fluttering, Bell., Calc. ostr., Carl., Cup., Cup. (1.), Mag. c. (r.), Mag. m., 
 Mag. m. (r.), Merc, Merc. d. (1.), Merc. sol. (1.), Mur. ac, Nit. ac. Plat., 
 Pul. n. (r.), Sel., Sil., Spig., Sul.; at ii a.m., Mag. c. (r.) ; with hard hear- 
 ing, Mag. c, Spig. ; warmth, Mang. ; numbness as if drunk, in open air, does 
 not understand what he is asked, Mag. c. ; before ears, Mang. (1.), Merc, 
 sol. (1.) ; morning after waking. Bell. ; 5 P.M., Sul. (1.) ; as from a bird. Ant. t. 
 {!.); evening, Mag. c. (r.). Tab.; rpiythmical, Sil. (1.); like wings, 
 Cham., Jac, Mag. c, Mag. c. (r.), Pho. ac. ; a bat's wing. Mil. ; a butterfly's, 
 Na. m.; during dinner, Na. m. (1.). 
 
 Groaning, Thu. (r.). 
 
 Growling (like a bear), Anac, Am. m., Aur., Bell., Bry., Cans., Con., Kre., 
 Lach., Lye, Na. c, Na. m.. Nit. ac, Nx. v., Pul., Saba., Sep., Sil., Spig., 
 Sul.; with buzzing, after roaring. Bell.; followed by ringing and hissing, 
 Kre. 
 
 Grumbling, Sil.; night. Am. m. (r.). 
 
 Gurgling, Aga. m., Ammc, Bar. c. Bell., Berb., Cans., Dul., Grap., K. ca., 
 Lact., Lau., Lye , Mag. c, Mur. ac, Olnd., Pho., Plat., Sang., Sep., Sil., Zn. ; 
 WITH loud noises, Rhodo. ; synchronous with the pulse, Merc, c; as if 
 
EAR: INTERNAL. — GURGLING. — MUSICAL. 245 
 
 WATER were in the ears, Rhode, Spig., Sul.; as if water were running from 
 a bottle or down the gullet, Grap. 
 
 Grunting, on swallowing, Calc. c. 
 
 Guns, reports of, Cannab. i. 
 
 Hammering, Spig., Thu. ; with hard hearing, Croc, Pso., Sil.; coldness of 
 whole body, Thu. ; much urination, Thu. 
 
 Hissing, Aeon., ^th.. Alum., Cai., Calc. c. (r.), Chel., Chin, s., Coc. c. Dig., 
 Gam., Grap., Hep., 111., K. ca., Kre., Led., Lye, Mag. c. Mar., Mur. ac, 
 Na. s. (1.), Nx. v., Pic. ac, Sil., Sum.; morning, from forcibly drawing air 
 in nose, from eructations and passing hand through hair, Mar. (r.) ; even- 
 ing, Calc. c. ; after forcibly inhaling air through nose and when talking. 
 Mar.: with hard hearing, Dig.; ringing, after growling, Kre.; sensation of 
 wind in ears, Dig ; ringing, Nx. v. ; as from boiling water, Bry. (1.), Dig. 
 
 Howling, with deafness. Con., Kre., Sil. ; deep-toned, and synchronous with 
 pulse, Sep. 
 
 Humming, Aeon., All. s., Am. m., Amyg., Anac. (1.), Ant. cr., Arn., Aur., 
 Bell., Benz. ac, Benz. ac. (1.), Bry., Bry. (1.), Calc. c, Calc. ostr., Canth., 
 Garb, ac. Garb, v., Carbn. s. (1.), Card, b., Carl., Chel., Cinch., Cob. (1.), 
 Coca, Cop., Con., Croc, Der., Dro., Fer., Feru., Fl. ac. Gam., Gel., 
 Glo., Grap., Jal., K. ca., K cl., Kre., Lach., Lye, Lye. (r.), Mag. m., Merc 
 (r.), Mez. (r.), Mur. ac, Na. m., Nice, Nit. ac, 01. an., Op., Pho., Pb., Piil., 
 Ric, Saba., Sang., Sec c, Seneg., Sep., Sil., Spig., Stry., Sul., Tab., Verat. 
 v.. Zing.; morning after rising, Ars. ; on waking, Na. m., Rhodo. ; 11 a.m.. 
 Zing.; evening, Sep.; on forcing air into it, before dinner, Saba.; after 
 itching, Na. m. ; lying down, All. c ; TALKING or whistling, Op. ; 
 (agg.) loud noise on going into open air, Tab. ; when sitting. Bell. ; (amel.) 
 laying head on table, Fer. ; lying, standing, or walking, Bell. ; with dull 
 hearing, Nice, Sec. c; roaring. Con. (r. and 1.), on stooping. Croc; roaring, 
 also in the head, Caus. ; sensation as if something heavy fell and burst, then 
 loud ringing, Saba.; heaviness in head, Ars.; lying in a stupor, Carbn. o. ; 
 followed by itching, Na. m. ; like BEES, Art. ab., Nx. v., Sal. ac. ; before 
 ears, Aur. (1.), Carb. v., Dro., Kalm., Kre. (1.), Lact., JNIag. m., Rhodo.; 
 DULL, morning on rising, Sil.; extending to back of head, Carbn. s. (1.), 
 Spig. (1.) ; as if about to faint, Merc. ; as from insects, Meny. ; like a 
 spinning-wheel, Aga. m. ; as if something were sticking in ear, Mere 
 sol. (1.) ; like WASPS, Merc 
 
 Knocking, Nit. ac ; and clapping, Pho. ; out of doors and some one calling 
 him, in a dream. Ant. cr. 
 
 Loud, Mag. s. (1.), Sul.; after dinner, Mag. e (r.) ; in a dream, Stan.; and a 
 pistol-shot, in a dream, waking him, Cerv. ; with hard hearing, Merc. 
 
 Machinery, 2 p.m., Hydrs. 
 
 Mill, Cie v. (1.), lod., Nx. v., Petrol. ; at a distance, Mez. (1.), Bry. (1., then r.) ; 
 going in the head, morning on waking, Naj, 
 
 Murmuring, Bell., Hep. (1.), Sil.; after sleep, < mental anxiety, Act.; be- 
 fore ear, in evening after lying down, Hep.; rhythmical with pulse, Carl., 
 Pul., Sec. c 
 
 Musical, Na. e, Pul., Sal. ac, Sep., Sil.; evening on lying down, Pul. ; after a 
 dream that he heard music, Sarr. ; in the evening, the music that she heard 
 
246 EAR: INTERNAL. — NOISES. — RINGING. 
 
 in the daytime, Lye. ; with diminished hearing, fear of apoplexy, great 
 noise in the ear, distraction, and loss of memory, Cannab. 
 
 Nail driven into a board at a distance, Aga. m. 
 
 Noises, Aeon., Arun., Bell., Bol. s., Calc. c. (1.), Calc. ph., Camph., Carbn. 
 o., Carbn. s. (1.), Chel. (1.), Croc, Coff. t.. Dig., Euphm. (r.), Hydrs., Hyos., 
 K.ca., Lye, Mag. s. (1.), Na. m., Na. s.. Nit. ox., Pho., Rhu. v. (r.), Sep. (r.), 
 Spig., Stry. (I.), Sul., Tab., Tarent., Tep., Verat. v., Zn.; morning, Alum., 
 Arg. n., Aur., Bell, Calc. ostr., El. ac. Gam., Grap., Lach., Lye, Mag. c, 
 Mang., Merc, Mez., Na. c, Na. m., Phel., Plat., Pul., Rhodo , Sil., Sul., 
 Tab., Val., Zn. ; in bed, Mag. c (1.); 8 A.M., Phe. ; afternoon, Ambra, 
 Ant. cr., Carb. v., Nit. ac, Pul., Rhu. t. ; evening, Alum., Bar. c, Canth., 
 Caus., Grap., Lact., Lye, Mag. c, Merc, Nice, Ol. an.. Petrol., Pho. ac. 
 Plat., Rhodo., Sep., Sul., Sul. ac, Zn. ; night. Am. car., Am. m., Bar. c, 
 Carb. a., Con., Croc, Euphm., Grap., Hep., Mur. ac, Nx. v., Pho. ac, Rat., 
 Sep., Sil., Thu., Zn. ; on waking, Hydrs.; midnight on waking. Rat.; after 
 repeated small doses of alcohol, Ars. ; in bed, Tarent (< r.) ; on blowing 
 nose, Carb. a., Lye, Mar., Meny. ; boring in with finger, Castor., Chel, 
 Lach., Nice; on chewing. Alum., Ant. cr., Carb. v.; on eating, Con., 
 Grap., Na. m., Sul., Sul. ac. ; after eating, Canth., Cinnb., Con., Grap., Mag. 
 c. Op., Sil., Zn.; on waking after dreams. Bell., Grap., Lach., Na. m., 
 Nx. v.. Rat., Sep. ; in doors, Cic v., Mag. e; out of doors, Aga. m., Benz. 
 ac, Carb. a., Mag. e, Tab.; after mental exertion. Con. ; during full 
 moon, Grap.; on opening mouth, Dul., Sul. ac. ; passing finger over 
 cheek, Sang. ; handover ear. Mar.; on rubbing or scratching, Meny. ; 
 on going to sleep, Zn. ; on swallowing. Alum., Benz. ac, Cic. v., Coe e, 
 Grap., Lepi., Ti//^., ^/7. ; on empty swallowing, Thu.; on quick walking, 
 Pho. ; after writing, Sep., Zn.; (agg.) after eating, Carbn. s. (1.) ; on wak- 
 ing, Tarent. (< r.) ; (amel.) after headache, Tarent.; with, or alternating 
 with ear symptoms, Anac, Arn., Bell., Carb. v.. Chin., Lach., Lye, Merc, 
 Nit. ac, Nx. v., Pho., Pul., Sep., Spig., Sul., Zn. ; with digging pain extend- 
 ing to nostril, and hard hearing, Jac ; discharge, Calc ostr. ; deafness, dull 
 hearing, Merc, so that music nauseates, Sul. ; rushing, and roaring in head, 
 Lach.; anxiety, Pul., Sil. ; insanity, Ars.; desire to be alone, Con., and at 
 rest, Bell. ; hatred of company, Bell., Pho. ; distraction of mind, and loss of 
 memory, Camph. ; hypochondriac mood, anxiety, Pul. ; hypochondriac 
 humor, and confusion of mind, Agn., Bap., Carb. a. ; want of memory, Mos. ; 
 starting, frightened, Mil., when falling asleep, Sul. ; vertigo, Tep. ; dimness 
 of vision, K. bi. ; red eyes, Glo. ; tears and coryza, Bry. ; belchmg, Carb. 
 a., Grap. ; sleeplessness. Bar. c ; horripilation. Alum. ; alternating with 
 dull hearing, Anac. ; SUDDEN, Ast., Mur. ac. 
 
 Piping, Bor. (r.). Lye 
 
 Quivering, Bov., K. iod., Spig. 
 
 Pulsation of carotids, Verat. (1.). 
 
 Railroad train in a tunnel. Nit. ox. 
 
 Rain, (Bov.) ; striking the ground, Rhu. t. (1.). 
 
 Rattling, with noise as if some one were under the bed, Canth. 
 
 Reports, Eup. pur.. Nit. ac, Stajx 
 
 Ringing (compare with bells), Acoji. c, Aeon., Aga. m. (1.), Ag7t., 
 
EAR: INTERNAL. — RINGING. 247 
 
 Alec, Ail, (r-.), All. c, Aloe, Ambra, Am. car., Am. m., Anac, Align., 
 Angu. (r.), Ant. cr., Arg. n., Am., Arn. (1 ), Ars., AsAF., Asar., Ast., Atro., 
 AuR., Aur. m., Bar. c. Bell., Bor. (r.), Bro. (r.), Bry., Brucn., Calc. cau., 
 Ca]c. c, Calc. ostr., Calth., Camph., Cannab. l, Cannab. s., Canth., Cap., 
 Carb.a., Carbn. o., Carbn, s., Carb. v., Carl., Castor., Caus., Caus. (1.)„ 
 Cham., Cham, (r.), Chel., Chin., Chin. s. (< I.), Chlf., Chlo. (r.), Chlol, 
 Cic. v., Cic. V. (1.), Cinch., Cit. v., Cle., Coc, c. {l.),Coca, Cod., Coff., Colch., 
 Colch. (r.), Coloc, Com., Con., Con. (r.), Croc, Cup. ac, Cyc, Dig., Did., 
 Elap., Ery. a. (1.), Euphb., Euphm., Fer., Fer. (r.), Gam., Gas., Gin., Glo., 
 Gran., Grap., Grap. (1.), Guare., Hell., Hell, v., Hep., Hyos., Hydrc, 
 Hydrs., Hur., Ig., 111., lod., K. ca., K. cy., K. bi., N. iod., K. n., Kis., Kre., 
 Each., Lachn., Led., Lyc, Lye. (r.), Mag. c, Mag. s., Mag. s. (1.), Mane., 
 Mang., Mar., Meny. (r.), Merc, Merc, cy., Merc, n., Merc, sol., Mez., Mil. 
 (r.J, Mor., MuR. ac, Myric. (1.), Na. c, Na. m., Na. sa., Na. slfc. (r.), Nice, 
 Nitr., Nx. v., Olnd., Ol. an., Op , Osm., Paeo., Far., Pb., Pb. cr.. Pen., 
 Fetrol.,V\it\., Fho. {<x.), Fho. ac. Plan., Plat., Pso., Pte., Pul., Fyrt^s, 
 Rat., Rhodo., Rhu. t., Rhu. v. (r.), Rum. c. Rut., Saba., Sal. ac. Sain., 
 Sars., Sars. (1.), Scr., Sec. c, Sel., Sil., Spig., Sol. t. as., Spo., Spo. (r.), 
 Stan., Stan. (1 ), Stram. (< 1.), Stap., Stap. (1.), S7d., Sul. (r. and 1.), Sul. ac, 
 Sulphs. ac, Tab., Tana., Tarax., Tarent., Ter., Thu. (r.), Til., Val., Verat., 
 Verat. v., Vine, Vine, min., Vio. 0., Xan. (< r.), Zn., Zn. (r.) ; day, Sul. ; 
 MORNING, Cle. ; in bed, Arg. n., Sul.; on rising, Mez. (r.) ; forenoon, 
 Carb. v., Fl. ac. (r.) ; 2 a.m., Chin, s.; 9 a.m., before headache, > cold water, 
 Euphr. (1.); during coldness, Chin. s. ; 11 A.M., Na. m. ; noon, Glo. (1.) ; 
 afternoon, Carb. v. (1.), Kalm., Sul. (r.) ; when writing, Carl, (r.) ; EVEN- 
 ING, K. n., Sil.; in bed. Croc, Pho., Val.; 2 p.m., Verat. v.; 3 P.M., Fago. 
 (1.) ; 4 P.M , Dios. (< r.) ; 5.45 P.M., 01. an. ; 7 P.M., Physo. ; 8 P.M., Ham. ; 
 NIGHT, Carb. a., Cyc, Pho. ac, Zn., Zn. (r.) ; MIDNIGHT, on waking. Rat. ; 
 on going into open air, Carb. a. (r.) ; boring in with finger, Chel. ; during 
 DINNER, Sid. ; after dinner, Mag. c (r.) ; in a dream, it wakens him, and he 
 hardly believes it to be a dream, Zn. c ; while eating, Sul. ; on closing 
 EYES, Chel.; moving head, Stap. ; blowing nose. Mar. (r.) ; after a noise 
 like a blow inside, Na. m. ; after shocks and contractions in ears, Na. m. ; 
 when sitting, Ars. (r.). Mere, cy., Sul.; on sneezing, Euphm.; after stool, 
 Apoc. c (r.); when talking, Spig.; on waking, Tarent. (r.) ; when walk- 
 ing, Chel. (1.), Mane, Nice, Rhu. t. ; in open air, Aga. m. (r.) ; (agg.) even- 
 ing, Merc, sol.; night, with headache, Cyc; after lying down, Sid.; 
 (amel.) cold water, Euphr. ; digging into, Nice ; during rest, Stap. ; on 
 rising, Tarent. (r.); rubbing, Meny. (r.) ; with deafness. Con., Sul.; hard 
 hearing, Arg. n., Grap., Led., Pso., as if plugged up, Mez. ; hissing, after 
 the growling, Kre.; roaring and dull hearing as if a skin were stretched 
 over the ear, Cannab. s. ; roaring, tearing, and twitching, from one's own 
 singing, Pul. ; whistling, Vin. min. ; crawling tickling, Cinch. ; illusions, 
 Val. ; headache, Aeon, e, Carbn. s.. Cinch., Euphr., Gin. ; vertigo, Carb. v., 
 cold stage. Chin., Grap., Rhu. t. ; followed by hard hearing, Aur. m. ; 
 alternating with ticklmg itching in right Eustachian tube, Aga. m. (1.) ; 
 rushing, Grap., Mag. s. ; before ears, Ant. cr., Arg. n., Asaf., Bry. (1.), 
 Calc. c, Carbn. s., Carb. b., Chel. (1.), Cle., Rhodo. ; evening, Caus. (r.) ; 
 
248 EAR: INTERNAL. — ROARING, WITH BUZZING. 
 
 during mania, (Ars.) ; during internal coldness, Amyg. ; beginning deep, 
 then becoming higher, Berb. ; distant, All. c. (< r.), Arg. n., Coca, 
 Croc, Led., Spig. ; intermittent, Mil. ; dull, Pso. (L), Spo. ; fine, 
 Pul. ; FLUTTERING, with hard hearing, Bell., Mag. c, Rhe.; as from high- 
 sounding GLASSES, < evening, Merc. sol. ; rattling on a waiter when it is 
 shaken, Zn. ; LOUD, driving out of bed, SiL; like music. Ail., Pho. ; as if 
 ear were shut up, then opening with a clap. Mar. ; shrill, stupefying, sud- 
 den, Na. m. (r.) ; SUDDEN, and ceasing suddenly, Ast. r. 
 
 River running, Cact. 
 
 Roaring, Aeon., Aeon, c, Aconin., Aga. m. (1.), (r., then 1.), Ag7t., Alco., Ain. 
 car.. Ant. cr.. Ant. t., Apom., Arn., Ars., Atro., Bar. c, BelL, Benz n., Berb., 
 Bism., Bor., Bov. (1.), Bro. (< 1.), B)y. (1.), Cai., Cala., Calc. cau., Calc. c, 
 Calth., Camph., Canch., Cannab. s., Carb. ac, Carbn. h., Carbn. o , Ca7'b. v., 
 Carl., Castor, (r.), Caus. (r.), Cham., Chel., Chin, Chin, s., Chlf., Cic. v., 
 Cinch , Cit. v., Cle., Coca, Cocc, Coc c (1.), Coff., Coff. t., Colch., Coloc, 
 Con., Con. (r.), Conin., Croc, Crot. t.. Cup. ac, Cyc, Uaph., Dig., Dir. (r., 
 then 1.), Dul., Euo., Fer. i., Gas., Grap. (1.), Guare., Hell., Hell, v.. Hep., 
 Hey. ac, Hyos., lb., Ig., 111., Indg., lod., Jat., K. bi., K. ca., K. clo., K. iod., 
 Kis., Lach., Lact., Lau., Led., Lepi., Lip., Lol.. Lye, Mag. c, Mag. c. (r.), 
 Mag. m.. Mane, Mela. (1.), Merc (r.), Merc, c (r.), Merc, sol., Mor., Mur. ac. 
 (r.), Na. c, Na. ra. (1.), Nice , Nit. ac, Nx. v., Ol. an., Olnd., Op., Paeo., 
 Pau. p., Pb., Petrol., Pho. ac, Pho., Pimp., Pin. s.. Plat., Pie., Pso., Pte., 
 Pill., Rhe. (r.), Rhodo., Rhu. t., Sal. ac. Sec. c, Seneg., Sep., SiL, Spig., 
 Spigg., Spo., Stap., Stram., Stro. (r.), Stry , Sul. ac, Sul., Tab., Tana., Tep., 
 Thea., Ther., Thu. (1.), Til., Wies,, Zn. s. Zn. ; day, Sul.; morning. Alum., 
 Calc. c, Merc sol., Pho. ac. Plat. ; in bed, Aur., Na. m. ; after rising, Calc. 
 z.,Nx.v.; on waking, Hype. (< 1.) ; 2 a.m., Pte. ; 11 a.m., Mag. c (r.) ; 
 afternoon. All. c (1.), Ambra, Ant. cr., Cham.; coming from open air, 
 Thu.; and on rising, Lac ac. (1.); evening. Alum., Caus., Pb., Petrol., 
 Pho. ac, Thu. (1.); in bed, Sul. ; after lying down, Plat.; after going to 
 sleep, Calcc, Sul. ac. ; while sitting still. Op.; 3 p.m., Elap., Mag. c (r.) ; 
 8 P.M., Ped. ; 9 P.M., Hydrs. ; before midnight, Euphm. ; night. Am. c (1.), 
 Cinch., Euphm., Grap., Lepi. (r.) ; from dreams, Nx. v.; on waking, Con.; 
 from BEATING OF pulse, Zn. (1.); in bed. Am. car. (r.), Aur., Merc, sol.; 
 on blowing nose, Meny. (1.); after eating, Cinnb., Op.; before menses, 
 Bor.; during menses, Bor., Petrol., Verat. ; after the noise of trumpeting 
 and drumming, Bell.; on rising. Aeon, c, Pho.; from a seat, Verat.; while 
 sitting, Con., Na. m. ; at every sound, Coloc. ; after spasms, Alco., Ars.; 
 while straining at stool. Lye. ; after stooping, Mang. ; after supper, 
 Canth. ; on WALKING, Colch., Cyc, Fer, Na. m. ; from yawning, Verat.; 
 (agg.) towards evening, Pte., Spig. ; in bed, Con. ; after dinner, Con. ; while 
 eating, Con. (1.) ; in house, Cic v., Mag. c (r.) ; motion, Na. c ; loud noises, 
 01. an.; speaking, Na. c ; (amel.) sitting up in bed, but returning immedi- 
 ately. Am. car. (r.) ; swallowing, Rhe. (r.). 
 
 — With buzzing and itching, Sep.; discharge, Bor.; hard hearing, Aur., 
 Bor., Croc, Grap., Merc, Sen^g., Sep., Thu. ; humming. Con. (r. and 1.), 
 also in head, Caus., on stooping. Croc ; itching, Sep. ; pain, Ars. ; re- 
 laxed sensation of drum, Rhe. ; ringing, tearing and twitching, from 
 
EAR: INTERNAL. — WITH BUZZING, WIND. 249 
 
 one's own singing, Pul. ; rushing, Ammc, Am. car., Calc. ostr , Con., 
 Hep., Lye, Merc, Nit. ac, Pho. ac. Sep., during hot stage, Ars., Bry., 
 Xx. v.; rushing, with shattering pain in head, Plat.; rushing, with fire 
 before eyes, Verat. ; stitches, Caus., Nit. ac. ; stopped feeling, Grap., 
 j\Ierc. c, Seneg., Sep. ; increased EARWAx, Mur. ac, Sep. ; running of 
 wax, Grap.; dulness of SEXSORIUM, Arg. n.; headache. Gel., Hal.; ver- 
 tigo. Bell., Grot, t., Gran., Hell., Na. c ; heaviness of head, Murx. ; cataracts 
 of eyes. Sec. c. ; Coryza, Sep.; swelling of face, Cinnb. ; pain in abdo- 
 men. Pell.; COUGH, All. c, Caus., Con.; fever, Lach. 
 Roaring. Followed by growling and buzzing. Bell. 
 
 — Alternating, with whistling, rvrag. c 
 
 — Beating, Lach. ; morning after waking, > shaking finger in ear, Lach. 
 
 — Bed, driving out of, Mag. c. 
 
 — Before, Am. c. (1.), Anac, Bar. c. Card, b., Caus., Dro., Gran., K. n., 
 
 Merc. sol. (1.) ; after eating, Sil. (1.) ; morning, after rising. Alum. 
 
 — Benumbing, Bar. c, Olnd. 
 
 — Blood rushing, like. Petrol., Stan. 
 
 — Bubbling, Aga. m. (1.). 
 
 — Deep-toned, nights when lying on ear, Sep. 
 
 — Distant, Pimp., Pul. 
 
 — Draught through a stove, Thu. 
 
 — Dull, Arg. n.. Til. ; every morning, and in evening after lying down. Plat. 
 
 (r.) ; in forenoon. Coca; after eating. Op. 
 
 — Fluttering, of a bird, Plat, (r.) ; like a partridge, evening on waking, 
 
 Hydrs. ; like a fire in a chimney, a low, dull sound. Bell., Berb., Con., 
 DuL, Lau., Lye, Mag. c, Olnd., Petrol., Pho., Tlat., Rhodo., Spig., Spo., 
 Zn. 
 
 — Pulse, sj-nchronous with, Merc. sol. ; at night, K. br., Sep. ; on walking, 
 
 Aeon, c 
 
 — Resounding, Bar. c. 
 
 — River, like a, Cact. 
 
 — Rhythmical, Coloc (1.), Sul. ac. 
 
 — Sea-shell, like. Rum. c (1.); with hard hearing (after Sul.), Lach. 
 
 — Seething, Coc c (1.). 
 
 — Sticking in ear, as if som.ething were, Merc. sol. 
 
 — Storm, like a. All. c, Bor., Chel., Coc c. Con., Led., Mag. c, Pul., Sul., 
 
 Verat. ; storm in a forest, Coc. c 
 
 — Sudden, Ast., Bry., Mez. (r.) ; extending into forehead, > hand over eye, 
 
 Spig. 
 
 — Tube, as when ear is applied to, Cocc. 
 
 — Water, Ars., Ast., Caus., Cham., Chin, s., Cocc, Con., Mag. c, Mag. 3. 
 
 (1.), Petrol., Pul. ; boiling, Chlf. ; rushing, Cham. ; in evening, Petrol.; 
 7 P.M., Mag. c. (r.) ; waterfall, Ther. ; on opening mouth during din- 
 ner, Sul. ac. 
 
 — Wind, Asar. (1.), Caus., Chel., Con., Croc, Led., Petrol., Verat.; 4.30 p.m., 
 
 Mag. c (1.) ; increasing to a bluster, Aeon., Agn., Ambra, Anac, Ant. 
 cr., Arn., Ars., ASAR., Aiir., Bell,, Bry., Calc. ostr., Cannab. s.. Garb, v., 
 Caus., Cic v., Cocc, Colch., Con., Dro., Fer., Grap., Hep., Ign., K. ca.. 
 
250 EAR: INTERNAL. — ROARING. — SINGING. 
 
 Led., Ta-c, Mag. c, Mang., Mag. m., Meny., Mor., Murx., Na. c, Nit. ac, 
 Nx. v., Op,, Petrol., Pho., Pho. ac, Plat., Pul., Rhe., Rhu. t., Saba., Sec. 
 c, Seneg., Sep., SiL, Stap., Snl., Tlivi., Verat. 
 
 Roaring. Twitching, at night, Nice. (r.). 
 
 Rolling, with confusion of head, Zn. cy. ; like thunder, Grap. 
 
 Rumbling, Apis, Equ. (1.), Gas. ; before ear, Bry. (r.) ; distant, evening in 
 bed, Sel. (1.) ; like a wagon, Am. m., Grap., Plat. 
 
 Running before ear, in afternoon. Am. car. (1.). 
 
 Rushing, Aga, m., Alco., All. c. Am. car. (r.), Bro. (r.), Cans, (r.). Bap., Bro. 
 (r.). Cap., Dul., Grap., K. ca., K. cy., Lil. t., Mez., Na. c, Pho., Phyt., Rum. 
 c, Sul., followed by Caic. ostr.. Tab., Tel., Ther., Verat. v., Vio. o. ; morv- 
 ING, Dul.; 9.40 P.M., Na. ar. (r.) ; afternoon. All. c. ; after midmght, 
 when lying on ear. Am. car. (r.) ; night, Ther. ; in bed, Na. m.; during 
 coition, Grap. ; on rising from seat, Verat. ; with hard hearing, Calc. 
 ostr.; feeling as if something heavy fell on the floor and cracked, after 
 which the noise continues a long time, Saba. ; roaring, Ammc, Am. car., 
 Calc. ostr., Con., Hep., Lye, Merc, Nit. ac, Pho. ac, Sep., during the hot 
 stage, Ars., Bry., Nx. v.; roaring with shattering pain in head. Plat.; roar- 
 ing in head, with better hearing. Galvanism, Lach. ; roaring with fire before 
 the eyes, Verat.; whistling, Sep.; dry earwax, Pho. ac. ; cough, Dul., Pho.; 
 cold stage, Ars., Pul. ; sweat, Ars., Bell., Calc. ostr., Caus., Grap., Hep., 
 Lye, Nx. v.. Pill., Saba., Sep., Sul.; followed by amelioration of hard 
 hearing, Lach.; alternating with ringing, Grap., Mag. s. ; as from blood, 
 Stan.; rushing through brain, Con.; distant, Bro.; disturbing sleep, 
 Euphm , Euphm. (r.) ; as in faintness, Mos. ; as of fulling-machine, 
 night, Nx. V. ; like a jerking sound of a locomotive, < lying, > rising, Aga. 
 m. (r.) ; like steam escaping, Glo. ; night after lying down, Physo. ; extend- 
 ing to occiput, Cass.; from a kettle, Glo. ; as from a storm, Eor. (1.) ; 
 sudden, Na. m. ; as from fluttering of a bird, Mos. (r., then 1.) ; as when 
 listening at a tube, Cocc. ; as of water, Cocc., K. n.. Nit. ox. ; after 4 p.m., 
 Fzil. ; with increased earwax. Petrol. ; falling water, Hydrphb. ; waterfall, 
 Ars., Caus. ; as of wind rushing out of ear, Art, ab., Mos., Sul. 
 
 Rustling, Am. cau., Aur., Bar. c. Bell., Bov., Carb. v., Cham., Chel., Cocc, 
 Con., Dul., K. ca., Mag. c, Mang., Mos. (1.), Na. c, Na. m., Nx. v., Pul., 
 Rhode, Rhu. v. (r.), Stan , Vio. o. ; on moving maxillary joint, Aloe (r.) ; 
 like a fly, Mos.; like a grasshopper, Stan. (1.). 
 
 Scraping, scuffling, Cham. 
 
 Screaming, on blowing nose, Pho. ac, Stan. ; shooting through limbs^ even- 
 ing in bed, Grap. 
 
 Seething, Aeon. ; like boiling water, Bry., Dig. 
 
 Shooting, distant. Am. c ; shooting in dreams, Am.m., Hep., Hur., Lach., 
 iJ/<?rr., Spo. ; dream that she was shot, Mag. s. : of a j^istol, and a loud 
 sound, in a dream, Cerv. 
 • Shrill, on blowing nose. Mar., Pho. ac ; stupefying, 01. an. 
 
 Singing, Aeon., Am. m., Arg. n. (r.), Arn. (r.), Asar., Bell., Calc. c, Calc 
 ostr., Calc. pal., Calc. ph. (< r.), Cannab. i., Carbn. o., Caus., Cer. s. (r.). 
 Chin, s., Coca (1.), Coff. t., Coloc, Cot. (1.), Erig. (r.), Ery. a. (1.), Fer., 
 Fl. ac, Gam., Gas., Glo., Grap., Ir. v., K. bi., K. ca., Lac. ac, Lach., Laehn., 
 
EA R : INTERNAL. — SINGING. — TR UMPE TS. 2 5 I 
 
 Lye, Mar., Mur. ac, Na. m. (1.), Ol. an., Olnd., Op., Pen., Petrol., Phel., 
 Pho., Pso., Pyro. carb., Sang., Sec. c, Sep., Sul. i., Sum., Ter., Vich. ; 8 A.M., 
 Phe. ; AFTERNOON, when walking in open air, Lachn. ; evening, Linu., 
 Merc. i. r.. Sum. (r.) ; 5 p.m., 01. an.; in open air, Lach. ; closing eyes, 
 Chel. ; while LYING, Cannab. i., Pho. ac. ; before menses, Fer. ; during 
 menses, Petrol. ; after the bursting noise, Saba. ; when walking, Lachn. ; 
 WITH hard hearing, Pso, ; hissing. Gam. (1.) ; snapping, Lact. ac. (1.) ; 
 whistling, and looking to see where it came from, Elap. ; delirium, Stram. ; 
 vertigo, Sang. ; spasm of stomach, Atro. ; alternating with throbbing, 
 Caus. ; after ringing and tearing. Plat. ; before ears, Lachn., Sep. ; as of 
 crickets, Caus., Ced. ; disturbing sleep, Grap. ; like a locust, > cold 
 air, afternoon, Rhu. t. ; periodical, Caujiab. i. ; shrill, Asar. (r.) ; like 
 STEAM escaping, after lying down at night, Physo. ; like boiling water. 
 Lye, Thu. ; like wind in ear, when walking in open air, Carbn. s. (r.). 
 
 Slamming, as of a door, Stan. 
 
 Snapping, Pul. n. ; with singing, Lact. ac. (1.) ; like a harp-string, Sul. 
 
 Sounding-board, like, when breathing, Bar. c. 
 
 Spattering, with hard hearing, Plat. ; then discharge of moisture, Spig. ; 
 then amelioration of hard hearing, Spig. 
 
 Splashing, like water falling, Ant. cr. ; as if filled with water, Grap. 
 
 Sputtering, Nit. ac, Pl.it., Sil., Spig. 
 
 Squashing, Calc. ostr., Spig., Std. 
 
 Squeaking, Eup. pur., Mar. ; like ^^oung mice. Lye, Rhu. t. 
 
 Steam escaping. See under Rushing and Singing. 
 
 Stunning, Bar. c. 
 
 SURRING, Mor. 
 
 Swashing, with cracking, on swallowing, Grap. ; as of water, Sid. ; when 
 
 moving jaw, Ant. cr. 
 Talking, Elap. ; after abuse of alcohol in small doses, Ars. ; in the corners 
 
 of the room, Ars. ; confused, Benz. ac. ; of a strange voice, follows it and 
 
 tilts against the door. Grot. c. ; two persons, in a dream, Stram. 
 Tea-kettle, at a distance, beginning to boil, Aga. m. 
 Thundering, Am. m., Calc. ostr., Caus. (r.), Carbn. o., Chel., Gas., Grap., 
 
 Lach., Plat., Sil.; at night, Am. m. (r.) ; while sitting. Am. m. (r.) ; in 
 
 dreams, Arn., Ars., Sul. 
 Ticking, C/n'n., Dro., Petrol., Ter.; evening, Na. m. (1.) ; like a distant watch, 
 
 Cinch. 
 Tick-tack, Gad. (r.). 
 Tinkling (compare with bells). Ant. cr., Atro., Calc. ostr., Cle., Croc, 
 
 Hyos., Kalm., Lau., Led., Mag. c, Mur. ac, Nitr., Osm., Pho. ac, Pul., 
 
 Spig., Sul. ac, Val.; like little bells, Brom., Bry. ; like glasses, Merc; 
 
 like a pane of glass breaking, Zn. 
 Tolling, as of church-bells. Alum., Am. car., Ars., Calc. ostr., Cle., Con., 
 
 Hyos., K. ca., K. ca. (r., then 1.), Led., Lye, Mag. c, Mang., Meny., Na. m., 
 
 Nitr., Phel., Pho., Rhodo., Sars., Sil., Sid., Sul. ac, Val., Zn. ; in afternoon, 
 
 Sars. (1.). 
 Trumpets, Bell., Gas.; and cymbals. Bell.; and kettledrums. Bell.; and 
 
 drums, then roaring, Bell. 
 
252 EAR: INTERNAL. — TUMUL T. — WINDMILL, 
 
 Tumult, Cocc. ; several weeks after wakes with a start during sleep, after 
 midnight, Rhu. t. ; a confused sound, after midnight, daily for some weeks. 
 Am. car. 
 
 Twanging, Pul., Saba. 
 
 Twittering, Cala., Coloc, Euphm., Mur. ac, Nx. v., Pul. ; as from a cricket, 
 morning in bed, Pul. ; like young mice, Rhu. t. 
 
 Voices. See Talking. 
 
 Vibrating, Grap., Pho., Tab. ; dull, Carbn. o., Thu., as when an iron rod is 
 struck, Pul.; as of the string of an instrument, Cannab. s. (1.). 
 
 Wabbling as from water, with over-sensitiveness, Sul. ; as if water were run- 
 ning before the ear, in afternoon, Am. car. 
 
 Walking behind him, he hears some one, Crot. c=, Bro. ; before his bed, at 
 night, Carb. v. 
 
 Warbling, as of birds. Bell., Bry. 
 
 Water, Nit. ac. ; boiling, Bry. (1.), Cannab. i., Dig. ; before ears, Bry. ; out 
 at ears, Sul. ; waterfall, Cannab. i., Chel., Con. (r.), Na. p., Petros., Sul. 
 ac. ; trickling, with sensation of wind in, Thu. 
 
 Waves, Ast. ; waving, Fago. ; with fretful impatience, Plat. ; jumping, as from 
 fleas, Mos. 
 
 Wheel, Cit. s., Hydrs. 
 
 Wheezing, Tarent. 
 
 Whirring, with confusion of head, Carb. a. 
 
 Whispering (hallucination), in evening, Rhodi. 
 
 Whistling, yEth., Alumn., Ambra, Aur., Bell., Bor., Carb. ac, Caus., Chel., 
 Caus. (1.), Elap., Fer., Grap., Hep., Hur., Lye, Mag. c, Mur. ac, Pul. (r.), 
 Sarr. (r.), Sep., Verat. (r.), Vin., Vin. m. ; 9 a.m , Hur. (r.) ; afternoon, 
 Ambra; evening when writing, Sep.; when blowing nose, Carb. a.. Hep. 
 (r.), Lye ; when walking. Mane; with ringing, Vin. m. ; rushing, Sep.; 
 alternating with roaring, Mag. c ; distant, Elap. ; extending through 
 every limb, Grap. 
 
 Whizzing, Alum., Arg. n., Berb. (1.), Calc a., Hur., Lach., Mag„ c (r.), Mim., 
 Naj. (1.), Olnd., Pb., Pho., Sang., Tarent., Thu., Zn. (r.) ; ham., Mag. c 
 (r.); evening, Zn. ; when writing, Sep.; while lying in bed, Plat.; when 
 whistling, Ped. ; > foot-bath, Tarent. ; with hard hearing, Mag. c. ; 
 rush of blood to head. Sang. ; like a pulsation in head, Spo. 
 
 Wind, Carbn. s. (1.), Led., Spig. (1.) ; 4 p.m., Pul. ; 4.30 p.m., Mag. c (1.) ; 
 < noise, Plat. ; passing rapidly, Spig. ; strong, before ear, Ign. ; whistling or 
 singing, Vin. m. See also under Roaring. 
 
 Winding of a watch, Ambra. 
 
 Windmill, in morning, Bry. 
 
INDEX, 
 
 Abscess, cerebral, 86. 
 
 Aconite, i6, 40, 51, 69, 141. 
 
 Adhesions, 80. 
 
 Agaricus mus., 141. 
 
 Alcohol, action of, 126. 
 
 Allen, T. F., 3, 38. 
 
 Antimonium crudum, 40. 
 
 Arnold, J. W. S., 38. 
 
 Arsenic, 17, 40. 
 
 Aspergillus flavescens, 18. 
 glaucus, case of, yj- 
 nigricans, 18 ; case of, 37. 
 
 Audiphone, 169. 
 
 Auditory nerve, changes in, 166. 
 torpor of, case of, 165. 
 
 Auricle, case of nasvus of, 32. 
 
 Aurum met., 141. 
 
 Bathmg, 49. 
 
 sea, 67. 
 Baryta mur., 142. 
 
 Belladonna, 15, 16, 40, 50, 51, 69, 87, 143. 
 Blake, J. Clarence, use of paper disks, 
 
 76. 
 Blake's Wilde's snare, 81. 
 Bougies, use of, 61. 
 Brenner, loi. 
 Buck's drills in mastoid disease, 84. 
 
 loop-probe, 22. 
 Burnett, Dr., 82. 
 
 comments on Meniere's proposi- 
 tion, 159. 
 
 case of hairs, 89. 
 
 Calcarea, 70, 87. 
 
 carb., 41, 124, 143. 
 
 Calcarea fluor., 87. 
 
 iod., 1 28. 
 
 phos., 77. 
 
 pic, 41. 
 Calcareous deposits, 27. 
 Cancer, 89. 
 Capsicum, 69, 87, 143. 
 Carbo animalis, 144. 
 Carbo veg., 41, 144. 
 Caries of cranial bones, 85. 
 
 squamous portion, 86. 
 Caisson disease, 28. 
 Causticum, 144. 
 Cerumen, accumulation of, 21. 
 
 causes of, 22. 
 
 symptoms of, 21. 
 
 treatment, 22 ; Buck's loop-probe, 
 22 ; method of syringing ear, 22. 
 Chamomilla, 17, 41, 50, 69, 144. 
 Chenopodium anthel, 177. 
 
 in torpor of auditory nerve, 165. 
 China, 144. 
 Chisels, 84. 
 Cicatrices, 80, 118^ 
 Cinchona, yj, 144, 177. 
 Climatic conditions, 49. 
 Clothing, importance of, 49. 
 Conium, 41. 
 Conversation-tube, 16S. 
 Cooper, Sir Astley, 62. 
 Cotton pellet, 73, 167. 
 
 cases of use of, 136. 
 Crosby, A. B., 83. 
 
 Dactylology, 170. 
 Daiby, W. B., 170. 
 
 253 
 
254 
 
 INDEX. 
 
 Deaf-mutism, 167. 
 dactylology, 170. 
 
 Dalby on lip-reading and articula- 
 tion, 170. 
 helps to hear, artificial membrana 
 tympani, 167. 
 audiphone, 169. 
 conversation-tube, 168. 
 cotton pellet, 167. 
 dentiphone, 169. 
 dipper-trumpet, 168. 
 North's earphone, 169. 
 instruction of deaf-mutes, 169. 
 lip-reading in the necessities of 
 every-day life, 171. 
 Deafness, relative, 72. 
 nervous, 157. 
 
 loss of high or low musical tones, 
 163. 
 Dentiphone, 169. 
 Dermatitis, case of chronic, 30. 
 Desquamative diseases, 89. 
 Diseases of the ear, 4. 
 
 advance in aural surgery, 5. 
 
 apathy of the profession, 5. 
 
 contrast between eye and ear, 5. 
 
 direct cause of death, 4. 
 
 effects upon life and usefulness, 4. 
 
 frequency, 4. 
 
 pathological study versus clinical 
 
 study, 5. 
 serious nature, 4. 
 
 Siegel's otoscope valuable in differ- 
 ential diagnosis, 11. 
 Diphtheria. 67. 
 Doughty, F. E., 161, 176. 
 Dulcamara, 69. 
 Dunham, Carroll, 3, 24, 79. 
 
 Eczema, 17. 
 
 Elaps, 78, 145. 
 
 Electricity, 70, loi, 105, 108. 
 
 Embolism, 89. 
 
 Exostoses, 82. 
 
 Explosions, injuries by, 27, 38. 
 
 External ear, otitis, 14. 
 
 otitis circumscripta, 14 ; cases of, 
 28, 31. 
 
 External ear, otitis diffusa, 16; cases of, 
 
 29. 32, ZZ- 
 
 otitis parasitica, 19; case of, 36. 
 
 summary of remedies : Aconite, 
 Arsenicum, Antimonium crud , 
 Belladonna, 40; Calcarea carb., 
 Calcarea picrata, Carbo veg., 
 Chamomilla, Conium, 41 ; Fer- 
 rum phos.. Graphites, Hepar 
 sulph.. Kali mur.. Kali phos.. 
 Kali sulph., Mercurius viv., 42; 
 Mezereum, Picric acid, Plantago 
 maj., Psorinum, 43 ; Pulsatilla, 
 Silicea, Sulphur, Tellurium, 44. 
 Eustachian catheter, 7. 
 
 Ferrum phos., 16, 42, 87, 146, 178. 
 
 Field, loi. 
 
 Food, importance of, 49. 
 
 Forceps, Sexton's, 19. 
 
 Foreign bodies, 25. 
 
 animate, 25. 
 
 case of, 39. 
 
 larvae, 25. 
 
 not a matter of great danger, 25. 
 
 methods of removal, Dunham, 
 Lowenberg, 24. 
 
 peculiar symptoms caused by, 26. 
 Fowler, William P., 75. 
 Fox, Tilbury, 90. 
 Furuncles, 15. 
 
 Galvanic and faradic currents, 70. 
 
 Gelsemium, 51, 69, 87, 146, 161, 178. 
 
 Graphites, 17, 42, 146. 
 
 Gray, John F., 88. 
 
 Green, J. Orne, testimony on Cinchona, 
 
 177- 
 Gruber, 62. 
 
 method, 60. 
 
 Haematoma, 18. ' 
 
 Hahnemann's psora theory, 34. 
 
 testimony on Cinchona, 178. 
 Hecla lava, 87. 
 Hemorrhage, 87, 90. 
 Hepar sulph., 15, 16, 42, 51, 70, 78, 87, 
 147, 180. 
 
INDEX. 
 
 255 
 
 Hering, remarks on compound reme- 
 dies, 15. 
 
 symptoms, 17. 
 HInton's operation, d'^. 
 Homoeopathic law, something in, 35. 
 H3-drastis canadensis, 78, 147. 
 Hydrobromic acid, 91, 178. 
 
 Internal ear, changes in auditory nerve, 
 166. 
 deaf-mutism, 167. 
 diseases, 157. 
 otitis, 157, 161. 
 
 case No. 21, p. 174. 
 exudativa, case of, 161. 
 secondaria, case No. 18, p. 175. 
 syphilitic cases, 164. 
 traumatica, 164; case, 171. 
 torpor of auditory nerve, case, 165. 
 Iodine, 147, 180. 
 
 Jasser, 83. 
 
 Kali bichrom,, ']Z, 127, 148. 
 
 brom., in labyrinthine vertigo, 160. 
 
 hydriod., ']Z, 140. 
 
 iod., 164. 
 
 mur., 16, 42, ']Z, 14S, iSo. 
 
 phos., 42. 
 
 salicy., 179. 
 
 sul., 42. 
 Kirchner, testimony on Cinchona, 
 
 177- 
 Knapp, Dr., 12, i6r, 169, 176. 
 
 prognosis in otitis interna, 176. 
 
 Lachesis, 149. 
 Latimer, Dr., 134. 
 Liebold, C. Th., 135. 
 Liel, Weber, 63. 
 Lilienthal, Samuel, 119. 
 Lowenberg, 24. 
 Lycopodium, 149. 
 
 Magendie's solution, 15. 
 Magnesium phos., 149. 
 Malleus, fracture of handle of, 28. 
 Markoe, 85. 
 
 Mastoid disease, 82. 
 Burnett, 82. 
 cases, 133, 134, 139. 
 diagram of cells and tympanum, 85. 
 symptoms, S3, 
 treatment, Buck's drills, 84. 
 
 free opening, 84. 
 
 perforation of mastoid antrum, 
 
 83- 
 Roosa, Schwartze, Crosby, 
 
 Jasser, 83. 
 Roosa's rules for operation, ^■^. 
 Schwartze's use of chisels, 84. 
 Measles, (i-j. 
 Meatus, foreign bodies in, 24 ; case of, 
 
 39- 
 
 case of ulcer upon upper wall of 
 externus, 29. 
 ]\rembrana t}Tnpani, artificial, 167 ; 
 Toynbee's, 75. 
 calcareous deposits, 27. 
 caisbon disease, 28. 
 destruction of, not a cause of total 
 
 deafness, 72. 
 injuries by explosions, 27. 
 lesions, 26. 
 myringitis, 26. 
 opacities, 27 ; tendinous and 
 
 fibrous, 27. 
 operations on, 61 ; Sir Astley 
 Cooper, Gruber, Politzer, Roosa, 
 Schwartze, Voltolini, 62 ; Vv'eber 
 Liel, (^T^. 
 
 Politzer's eyelet, 62. 
 
 division of posterior folds by 
 
 Politzer, (^i. 
 division of adhesions by Prout, 
 
 Hinton's operation, (yy 
 Howard Pinckney's use of Sie- 
 
 gel's otoscope, (^y 
 myringodectomy, 62. 
 ruptures, 28. 
 
 from blows on ears, 28. 
 in phthisis, 28. 
 Meniere, 159. 
 
 Mercurius, 15, 16, 50, 70, ']^^ 164, 179. 
 biniod., 149. 
 
256 
 
 INDEX. 
 
 Mercurius dul., 149, 179. 
 
 protoiod., 150. 
 
 viv., 42, 150. 
 Mezereum, 17, 43, 150. 
 Middle ear, cicatrices, 118. 
 
 electricity, use of, loi. 
 
 illustration of use of instruments 
 on cases, 100. 
 
 mastoid diseases, cases of, 133, 
 
 134, 139- 
 otitis, catarrhal acuta, 47. 
 
 cases, 94, 96, 108 ; No. 8, p. 92 ; 
 
 Nos. 13, 14, p. 93. 
 case with ecchymosis, 95. 
 otitis, catarrhal chronica, 53. 
 
 cases, 98, 102, 103, 104, 105, 
 106, 107, 109; Nos. II, 
 12, p. 99. 
 otitis, catarrhal subacuta, 52. 
 
 case with lymph exudation, 97. 
 otitis, suppurativa acuta, Q)^. 
 
 cases, no, in, 115; No. 7, 
 p. 114; No.9,p.ii3; No. 15, 
 p. 112. 
 otitis, suppurativa chronica, 71,81. 
 cases, 118, 119, 120, 121, 122, 
 123, 124, 134; No. 2, p. 132; 
 No. 3, p. 137; Nos. 4, 5, 
 p. 131. 
 cases with pol5TDus, 129, 130. 
 polypus, 124. 
 
 summary of remedies : Aconite, 
 Agaricus mus., Aurum met., 141 ; 
 Baryta mur., 142; Belladonna, 
 Calcarea carb., Capsicum, 143 ; 
 Carbo an., Carbo veg., Causti- 
 cum, Chamomilla, China, Cin- 
 chona, 144 ; Elaps, 145 ; Ferrum 
 phos., Gelsemium, ' Graphites, 
 146; Hepar sulph., Hydrastis 
 can.. Iodine, 147 ; Kali bich.. Kali 
 hydriod., Kali mur., Kali phos., 
 148 ; Kali sul., Lachesis, Lycopo- 
 dium. Magnesium phos., Mercu- 
 rius biniod., Mercurius dulcis, 
 149 ; Mercurius protoiod., Mer- 
 curius viv., Mezereum, 150; Ni- 
 tric acid, Nux vom.. Phosphorus, 
 
 Phytolacca, Psorinum, 151 ; Pul- 
 satilla, Quinine, Silicea, Sulphur, 
 1 52 ; Teucrium, Tellurium, Thu- 
 ya, 153- 
 unusual diseases, 88. 
 
 Burnett's case of hair, 89. 
 
 cancer, 89. 
 
 case, 90. 
 
 desquamative diseases, 89. 
 
 embolism, 89. 
 
 exudation of lymph, 90. 
 
 hemorrhage, 90. 
 
 pulsating tinnitus, 91 ; case of, 
 
 92. 
 objective sounds, 88. 
 Mirror, aural, 6. 
 Motives to study, 4. 
 Myringitis, 26. 
 Myringodectomy, 62. 
 
 Naevus of auricle, case of, 32. 
 Narcotics, ;^Ci, 50. 
 Nasal douche, 50, (^^. 
 
 case of bad effects, 98. 
 New-York Ophthalmic Hospital, 3. 
 Nitric acid, 151. 
 Norton, George S., 175. 
 Nux vom., 151. 
 
 Opacities, 27. 
 
 tendinous and fibrous, 27. 
 Otitis externa, 14. 
 Otitis externa circumscripta, 14, 
 cases, 28, 31. 
 causes of, 14. 
 incisions of furuncles, 15. 
 Picrate of lime from use of Hepar 
 
 sulph. and Picric acid, 15. 
 symptoms of, 14. 
 
 treatment of, 15 ; local applications, 
 Plantago maj., Magendie's solu- 
 tion ; remedies. Belladonna, Pul- 
 satilla, Hepar sulph., Mercurius, 
 
 15- 
 
 Otitis externa diffusa, 16. 
 
 aspergillus flavescens, 18. 
 aspergillus nigricans, 18. 
 case of, ■TiZ' 
 
INDEX. 
 
 257 
 
 Otitis externa diffusa, eczema of auricle, 
 Arsenic, Graphites, Mezereum, Psori- 
 num, Sulphur, for, 17. 
 pencillium, 19. 
 symptoms by Hering, 17. 
 Otitis externa diffusa acuta, 16. 
 case of, 29. 
 causes, 16. 
 
 remedies, Aconite, Belladonna, 
 Ferrum phos., Hepar sulph., 
 Kali mur., Mercurius, Pulsatilla, 
 16 ; Chamomilla, 17. 
 symptoms, 16. 
 
 treatment, 16; instrumental, 17. 
 Otitis externa diffusa chronica, case of, 
 
 32. 
 Otitis externa parasitica, 19. 
 
 case of, 36. 
 
 Sexton's forceps, 19. 
 
 symptoms, 19. 
 Otitis interna, 157, 161. 
 
 Burnett's comments on Meniere's 
 propositions, 159. 
 
 case No. 21, p. 174. 
 
 clinical cases versus fost-mortem 
 examinations, 157. 
 
 clinical observation and pathologi- 
 cal research, 157. 
 
 diagram illustrating physiology of 
 labyrinth, 158. 
 
 Knapp's prognosis, 176. 
 
 literature of, 157. 
 
 loss of high or low musical tones, 
 163. 
 
 Meniere, 159. 
 
 nervous deafness, 157. 
 
 summary of remedies : Chenopo- 
 dium anthel.. Cinchona, 177 ; 
 Ferrum phos., Gelsemium, Hy- 
 drobromic acid, Pilocarpin mur., 
 178; Salicylic acid, Salicylate 
 of potash, Salicylate of soda, 
 179. ^ 
 
 syphilitic cases, 164. 
 
 torpor of auditory nerve, case of, 
 165. 
 
 vertigo, case of labyrinthine, 160. 
 
 Voltolini, 161. 
 
 Otitis interna exudativa serosa, cases, 
 162. 
 case of exudativa, 161 ; Gelsemium 
 and Silicea in case of, 161. 
 Otitis interna secondaria, case No. 18, 
 
 P-_i7S- 
 Otitis interna traumatica, 164. 
 
 case, 171. 
 Otitis media catarrhal acuta, 47. 
 bathing, 49. 
 cases, 94, 96, 108 ; No. 8, p. 92 : Nos. 
 
 13, 14, p. 93 ; case with ecchymo- 
 
 sis, 95. 
 causes, 49. 
 
 climatic conditions, 49. 
 diagnosis, 49. 
 
 effects of vegetable diet, 50. 
 importance of clothing and food, 
 
 49. 
 narcotics, 50. 
 nasal douche, 50. 
 neglect of hygiene, 49. 
 not a local disease, requires con- 
 stitutional treatment, 47. 
 prognosis, 50. 
 remedies. Belladonna, Chamomilla, 
 
 Mercurius, 50 ; Gelsemium, 
 
 Hepar sulph., Pulsatilla, 51. 
 snuffing water, 50. 
 stimulating drinks, 50. 
 symptoms, 48. 
 treatment, 50; instrumental, hot 
 
 water, paracentesis, 51. 
 Otitis media catarrhal chronica, 53. 
 cases, 98, 102, 103, 104, 105, 106, 
 
 107, 109; Nos. II, 12, p. 99. 
 catarrhal form, pathological 
 
 changes, 57. 
 
 objective symptoms, 57. 
 subjective symptoms, 56. 
 causes of, 58. 
 division into catarrhal and post- 
 
 catarrhal, 56. 
 history of, 53. 
 post-catarrhal form, pathological 
 
 changes, 57. 
 
 objective symptoms, 57. 
 subjective symptoms, 57. 
 
258 
 
 INDEX. 
 
 Otitis media catarrhal chronica, co7i- 
 thtued. 
 
 treatment, instrumental and medi- 
 cinal, 58. 
 
 bougies, use of, 61. 
 Gruber's method, 60. 
 how long or when to treat, 61. 
 operations on membrana tym- 
 
 pani, 61. 
 remedies for excess of secre- 
 tion or dryness of mucous 
 membrane, 64. 
 Otitis media suppurativa acuta, 65. 
 
 cases, no, III, 115; No. 7, p. 
 114; No. 9, p. 113; No. 15, 
 p. 112. 
 causes, (£. 
 
 dentition, 67. 
 diphtheria, (d"], 
 measles, d"]. 
 scarlet-fever, (fj. 
 snuffing water, 67. 
 sea-bathing, (y']. 
 use of nasal douche, dG. 
 course of, (o(i. 
 diagnosis, 68. 
 prognosis, 68. 
 
 remedies. Aconite, Belladonna, 
 Chamomilla, Capsicum, Dulca- 
 mara, Gelsemium, 69 ; Hepar 
 sulph., Mercurius, Pulsatilla, 
 Psorinum, Sulphur, Tellurium, 
 70. 
 symptoms of, 65. 
 treatment, d'^. 
 
 electricity, galvanic and fara- 
 
 dic current, 70. 
 paracentesis, 68. 
 ^Yinslow, 69. 
 Woakes, Dr., 67. 
 Otitis media suppurativa chronica, 71. 
 careless removal of crusts, '](i. 
 cases, 118, 119, 120, 121, 122, 123, 
 124,134; No. 2, p. 132; No. 3, 
 p. 137 ; Nos. 4, 5, p. 131 ; with 
 polypus, 129, 130. 
 consequences of, 80. 
 
 caries of cranial bones, 85. 
 
 Otitis media suppurativa chronica, con- 
 sequences of, continzied. 
 
 caries of squamous portion, 86. 
 cerebral abscess, Z6. 
 cicatrices and adhesions, 80. 
 exostoses, 82. 
 hemorrhage, 87. 
 mastoid disease, 82. 
 paralysis, ^6. 
 phlebitis, 86. 
 polypus, 81. 
 pyaemia, 86. 
 deafness of, 72. 
 
 destruction of membrana tj^mpani 
 not a cause of total deafness, 72. 
 Dunham, Dr. Carroll, 79. 
 history, y;^. 
 
 loss of taste and sensation, ^6. 
 otorrhcea, 71. 
 prognosis, 71,. 
 
 remedies, Calcareaphos., Cinchona, 
 77 ; Elaps, Plepar sulph., Hydras- 
 tis canad., Kali bich., Kali 
 hydriod.. Kali mur., Mercurius, 
 Psorinum, Sulphur, 78; Tellu- 
 rium, Thuya, 79 ; Belladonna, 
 Capsicum, Ferrum phos., Gelse- 
 mium, Hepar sulph., Calcarea, 
 Calcarea fluor., Hecla lava, Sili- 
 cea, 87, 
 symptoms, 71. 
 time will not overcome, 73. 
 treatment, jt^. 
 
 artificial membrana tympani, 
 
 Toynbee's, 75. 
 cotton pellet, 73. 
 dry, yz- 
 
 Fowler, Dr. William P., 75. 
 instrumental interference, 75. 
 local applications, 74. 
 paper disks, Blake's use of, 76. 
 roll of paper, Yearsley's, 75. 
 sharp spoon, Wolfe's, 75. 
 syringe, 74, jy. 
 vertigo from use of syringe, yj. 
 wrong advice of medical faculty, 
 
 Otorrhcea, 71, 72. 
 
INDEX 
 
 259 
 
 Otoscope, Slegel's, as a means of pro- 
 ducing passive motion, 11. 
 
 Paper disks, J. Clarence Blake's, 
 
 Paper roll, Yearsley's, 75. 
 
 Paracentesis, 51, 68. 
 
 Paralysis, 86. 
 
 Pencillium, 19. 
 
 Phlebitis, 86. 
 
 Phosphorus, 151. 
 
 Phytolacca, 151. 
 
 Picrate of lime, 15. 
 
 Pilocarpin mur., 178. 
 
 Pinckney, Dr. Howard, on use of Sie- 
 
 gel's otoscope, 6t^. 
 Plantago maj., 15, 43. 
 Plympton, Clara C, 15. 
 Politzer, 62, 63. 
 eyelet, 62. 
 method of inflation, 9, 10 ; open to 
 
 objection, 11 
 on Pilocarpin mur,, 178. 
 Polypus, 81. 
 
 cases, 124, 126, 129; with otitis 
 media suppurativa chronica, 129, 
 130. 
 Studener, 81. 
 treatment, 81. 
 
 action of alcohol, 126. 
 action of Calcarea bich., 127. 
 action of Calcarea carb., 124. 
 removal by torsion, 126, 128. 
 Blake's Wilde's snare, 81. 
 Post, A. C, 3. 
 Prout, 12, (Sy 
 
 Psora theory, Hahnemann's, 34. 
 Psorinum, 17, 43, 70, 78, 151. 
 Pulsatilla, 15, 16, 44, 51, 70, 152. 
 Pulsating tinnitus, 91. 
 Pyaemia, 86. 
 
 Quinine, 152. 
 
 Record of cases should be full and com- 
 plete, 13. 
 
 Remedies not to be given on empirical 
 or vague indications, 35. 
 
 Roosa, 3, 12, 21, 62, S3, 89. 
 classification, 47. 
 
 rules for operation in mastoid dis- 
 ease, 83. 
 testimony on Cinchona, 177. 
 
 Salicylic acid, 179. 
 Salicylate of soda, 179. 
 Scarlet-fever, (y"]. 
 Schwartze, 62, 83. 
 
 use of chisels in mastoid disease, 
 84. 
 Searle, W. S., 161, 176. 
 Sensation and taste, loss of, 76. 
 Sexton's forceps, 19. 
 Siegel's otoscope, 11, (iT^. 
 Silicea, 44, 87, 152, 161. 
 Snuffing water, 50, 6^. 
 Sounds, objective, 88. 
 Speculum, aural, 7. 
 Spigelia in otitis interna, 175. 
 Stimulating drinks, 50. 
 Stop-watch, II. 
 Studener, 81. 
 
 Sulphur, 17, 44, 70, 78, 152. 
 Suppression is not removal, 36. 
 Syringe, use of, 22, 74. 
 
 Taste and sensation, loss of, "](). 
 Tellurium, 44, 69, 78, 153. 
 Teucrium, 153. 
 Thuya, 78, 153. 
 Torsion, 126. 
 Toynbee, 5, 7, 90. 
 
 artificial membrana tympani, 75. 
 Troltsch, 21. 
 
 pockets of, 93. 
 Trumpet, dipper, 168. 
 Tuning-fork, 12. 
 Turnbull on Hydrobromic acid, 178. 
 
 Ulcer in meatus externus, case of, 
 29. 
 
 Vegetable diet, 50. 
 Vertigo from use of syringe, 77. 
 labyrinthine, 160. 
 
26o 
 
 INDEX. 
 
 Valsalva's method, ii. 
 Voltolini, 62, 161. 
 
 Water, hot, 51. 
 Winslow, W. H., 69. 
 
 Woakes, Dr., d-], 91, loi. 
 
 on Hydrobromic acid, 178. 
 Wolfe's sharp spoon, 75. 
 
 Yearsley's roll of paper, 75. 
 

 
 LIBRARY OF CONGRESS 
 
 DD01fl4E=^t.fifl 
 
 -v- -^-^ vv^^v* u-^,4** -^(»*Aj(j c^ '^^^*rv 
 
 ^ .i *