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PRACTICAL LESSONS IN NURSING. 
 
 12mo. Extra Glotli. $1.00 each. 
 
 CHAS. K. MILLS, M.D. 
 
 THE NURSING AND CARE OF THE 
 
 NERVOUS AND THE 
 
 INSANE. 
 
 JOHN M. KEATING, IVI.D. 
 MATERNITY; INFANCY; CHILDHOOD. 
 
 The Hygiene of Pregnancy ; the Nursing and Weaning 
 
 of Infants ; the Care of Children in 
 
 Health and Disease. 
 
 E. T. BRUEN, M.D. 
 
 OUTLINES FOR THE MANAGEMENT 
 OF DIET; 
 
 Or, the Regulation of Food to the Requirements of Health and 
 the Treatment of Disease. 
 
 J. C. WILSON, M.D. 
 FEVER-NURSING. 
 
 INCLUDING : 
 
 Fever-Nursing in General ; the Continued Fevers ; the Period- 
 ical Fevers ; the Eruptive Fevers ; Fevers with 
 Marked Local Manifestations. 
 
 CHARLES H. BURNETT, M.D. 
 
 DISEASES AND INJURIES OF THE 
 
 EAR; 
 
 With Illustrations. 
 
 Structure and Functions of the Ear ; Common Diseases and 
 
 - Injuries of the Ear; their Prevention and Cure ; 
 
 Aural Hygiene of the Deaf. 
 
 For sale by all Booksellers, or will be sent, free of postage, on receipt of the 
 price, by the publishers, J. B. LippiNCOTT Company, 715 and 717 Market St., 
 Philadelphia. 
 
PRACTICAL LESSONS IN NURSING. 
 
 DISEASES 
 
 Injuries of the Ear: 
 
 THEIR PREVENTION AND CURE. 
 
 ^ 
 
 CHAELES HENEY BUENETT, A.M., M.D., 
 
 \\ 
 
 AURAL SURGEON TO THE PRESBYTERIAN HOSPITAL ; ONE OF THE CONSULTING AURIS 
 TO THE PENNSYLVANIA INSTITUTION FOR THE DEAF AND DUMB; LECTURER 
 
 ON OTOLOGY, WOMEN'S MEDICAL COLLEGE OF PENNSYLVANIA, IN 
 ^ PHILADELPHIA; EX-PRESIDF.NT OF THE AMERICAN OTO- 
 
 LOGICAL society; FELLOW OF THE COLLEGE OF 
 PHYSICIANS OF PHILADELPHIA. 
 
 / 
 
 PHILADELPHIA: 
 
 J. B. LIPPIXCOTT COMPANY. 
 
 London: 10 Henrietta Street, Covent Garden. 
 1889. 
 
? 
 
 '^> 
 
 b 
 
 
 Copyright, 1889, by J. B. Lippincott Company. 
 
PREFACE. 
 
 In the following pages the author has endeavored 
 to present the important subject of ^* Diseases and 
 Injuries of the Ear/^ in a form free from technical 
 terms, so that it may be understood by any one. 
 This plain description of ear-diseases, it is hoped, 
 will enable many to avoid them by care, or, if con- 
 tracted, will aid in recognizing their nature and thus 
 prevent experimental and erroneous forms of treat- 
 ment so much in vogue, and which usually do more 
 harm than good. The aim also has been to show 
 the inexpert what to avoid in the treatment of ear- 
 diseases, rather than what they may try to do for their 
 relief. In this way it is believed the general reader 
 can be best warned against error in treatment, and 
 the hearing saved. 
 
 If this little book can show how to take care of 
 the ears and avoid disease in them, or, if they are 
 diseased, how to escape the evils of improper treat- 
 ment, the author's object will be fully attained. 
 
 127 South Eighteenth Street, Philadelphia. 
 
CONTENTS. 
 
 PART I. 
 Structure and Function of the Bar. 
 
 CHAPTEE I. p^^^ 
 
 The Divisions of the Ear 7 
 
 The External Ear 9 
 
 The Middle Ear 13 
 
 The Internal Ear 20 
 
 CHAPTER II. 
 
 Physiology of the Ear 24 
 
 Sound 24 
 
 Hearing 25 
 
 F^ART II. 
 
 Common Diseases and Injuries of the Bar : their 
 Prevention and Cure. 
 
 CHAPTEE I. 
 Diseases and Injuries of the External Ear ... 35 
 
 CHAPTER II. 
 Diseases and Injuries of the Middle Ear .... 72 
 
 CHAPTER III. 
 Diseases and Injuries of the Internal Ear: the 
 
 Deaf and Dumb 132 
 
 1* 5 
 
CONTENTS. 
 
 F>ART III. 
 Aural Hygiene of the Deaf. 
 
 CHAPTER I. 
 
 PAGB 
 
 Aural Hygiene and Education oe Partially Deae 
 
 Children 142 
 
 CHAPTER 11. 
 
 Aural Hygiene and Education op the Deaf and 
 
 Dumb 147 
 
DISEASES 
 
 AND 
 
 INJURIES OF THE EAR; 
 
 THEIR PRETENTION AND CURE. 
 
 STRUCTURE AND FUNCTION OF THE EAR. 
 
 CHAPTER I. 
 
 THE DIVISIONS OF THE EAR. 
 
 The organ of hearing, or the ear, is the most com- 
 plex of all the organs of special sense. For the sake 
 of convenience in speaking and writing of the ear^ it 
 IS divided into three parts, — viz., the external, the 
 middle^ and the internal ear. 
 
 The external ear is composed of the auricle, com- 
 monly termed the ear, and the canal leading from it 
 to the drum (Fig. I., 14). This canal is termed the 
 external auditory canal. It is about one inch and a 
 quarter long. The auricle, the auditory canal, and the 
 drum-membrane are the only parts of the ear visible 
 from without. The other parts of the ear are situated 
 beyond the drum-membrane, and are, of course, in- 
 visible. . 
 
DISEASES AND INJURIES OF THE EAR. 
 Fig. I. 
 
 Si 
 
 3 4 5 
 
 Diagram of the entire Auditory Apparatus of Man; right side; nearly natu- 
 ral dimensions. (From "Hearing, and How to keep it," by C. H. Burnett, 
 ^[.D.) The front part of the auditory canal, the front half of the drum-mem- 
 brane, and part of the Eustachian tube are supposed to be removed. 1, the 
 side of the temple-bone cut through ; 2, outer surface of the temple-bone ; 
 3, upper wall of bony portion of hearing canal ; 4, ligament holding the 
 hammer-bone to the roof of the drum -cavity ; 5, roof and upper part of the 
 drum-cavity ; 6, semicircular canals ; 7, anvil-bone (incus) ; 8, hammer-bone 
 {malleus); 9, stirrup-bone {stapes); 10, cochlea (snail-shell); 11, drum-mem- 
 brane cut across and looked at sideways; 12, isthmus of the Eustacliian 
 tube, in the naso-pharynx ; 13, mouth of the Eustachian tube behind the 
 nose; 14, the auditory or hearing canal; 15, lower wall of bony portion of 
 the auditory canal; 16, lower wall of the cartilaginous part of the auditory 
 canal at its junction with the bony portion ; 17, wax-glands ; 18, the lobule ; 
 19, upper cartilaginous wall of the auditory canal ; 20, the mouth of the 
 auditory canal ; 21, the antitragus. 
 
 The middle ear is that part lying between the drum- 
 head, or drum-membrane, and the internal ear (Fig. 
 I., 5). In this cavity of the middle ear lie the three 
 ossicles of hearing, or auditory bonelets (Fig. I., 7, 8, 
 9). In the internal ear is the nerve of hearing. This 
 
THE DIVISIONS OF THE EAR. 9 
 
 part lies entirely in bone^ and is a small space. It is 
 near the brain, in the petrous or stony bone, so called 
 from its great hardness (Fig. I., 6, 10). The anatomical 
 knowledge of the ear is difficult, but it seems best to 
 give these few guiding facts as to the divisions of the 
 ear, in order to understand what is said of its diseases 
 and injuries. The chief object of this little work is to 
 guide the reader in the prevention and cure of diseases 
 and injuries of the ear. What is here set forth will 
 certainly therefore be better understood if the reader 
 has some idea of the general structure and function of 
 the different parts of the organ of hearing. 
 
 The External Eae. — The outer part of the ex- 
 ternal ear is the auricle. This is a cartilaginous shell 
 covered with delicate skin. The latter fits into every 
 groove, elevation, and depression of this cup, except 
 at its lowest part. Here there is found simply a 
 cushion of fat covered with skin. To this so-called 
 lobule (Fig. I., 18) ear-rings are often hooked. Nu- 
 merous blood-vessels, nerves, and lymphatics run 
 through the auricle. It is held fast to the side of the 
 head by ligaments and delicate muscles in man. In 
 the lower animals these muscles are strong and en- 
 dowed with the ability to move the auricle. The 
 skin of the auricle is abundantly supplied with seba- 
 ceous and perspiratory glands, like the rest of the 
 skin of the body. The sebaceous glands are most 
 numerous in the cup of the auricle, where it passes 
 into the mouth of the auditory canal (Fig. I., 17). 
 There is downy hair on the auricle. The long hair on 
 the bulbous projection at the mouth of the ear-canal is 
 a protection against cold air, insects, etc. The sweat- 
 
10 DISEASES AND INJURIES OF THE EAR. 
 
 glands of the auricle are most numerous on the back 
 of it, — an important fact to remember in the nursing 
 of infants; for if their auricles are pushed against their 
 heads and firmly held there, maceration and inflamma- 
 tion of the skin may ensue. 
 
 The Auditory Canal. — The auditory canal may be 
 considered the inward continuation of the auricle. It 
 is a canal one and a quarter inches in length by about 
 a quarter of an inch in width, and ends at the drum- 
 membrane (Fig. I., 11). The canal is a little narrower 
 half-way down than it is at either end. Its outer third 
 is composed of cartilage, while its inner two-thirds is 
 of bone. The skin which lines this canal possesses all 
 the elements of true skin. At its outer part, near the 
 junction of the cartilaginous with the osseous part, lie 
 the wax-glands (Fig. I., 17). These are fifteen hun- 
 dred in number, and secrete the very useful matter 
 called ear-wax. It will be further shown that this 
 substance is most important to the welfare of the ear. 
 
 The Drum-membrane. — The drum-head, or membrana 
 tympani, is the air-tight partition at the bottom of the 
 auditory canal, between the external and the middle 
 ear (Fig. I., 11). This is the part popularly called 
 the ^Mrum.^^ This is not an accurate terra, as it is 
 really only the outer wall of the drum-cavity or middle 
 ear, and might therefore be called the " drum-head." 
 The drum-head is nearly circular (Fig. II.), about a 
 quarter of an inch in diameter, and about ^^ of an 
 inch thick. The drum-membrane is composed of three 
 layers, — the outer one being of skin, a continuation of 
 the delicate skin which lines the auditory canal. The 
 middle layer is of fibrous tissue, and the inner layer is 
 
THE DIVISIONS OF THE EAR. 
 
 11 
 
 of mucous membrane, continuous with that which lines 
 the middle ear or drum-cavity. 
 
 In the central line of this drum-membrane is an 
 opaque, white ridge, running from above downward 
 and backward (Fig. II., 5). When the drum is in- 
 
 Outer Surface of the Drum-membrane. Magnified 33^ times. 
 (Politzer.) 1, 1, the flaccid part of the dnim-membrane; 2, the 
 short process of the hammer-bone ; 3, back fold of the drum- 
 membrane ; 4, the long limb of the anvil-bone, shining through 
 the membrane ; 5, 5, the true membrana tympani, or membrana 
 vibrans ; 6. 6, 6, 6, inner end of bony canal, forming frame for 
 drum-membrane ; 7, the pyramid of light ; 8, lower part of the 
 hammer ; 9, the front fold of the drum-membrane. 
 
 spected, this white ridge is the first glimpse the examiner 
 gets of the chain of auditory bouelets already alluded 
 to. This chain of little bones connects the drum-mem- 
 brane with the portion of the inner ear where the nerve 
 of hearing lies (Fig. I., 7, 8, 9). The white ridge just 
 mentioned is the so-called handle of the hammer, or 
 malleus, the largest of the three auditory bonelets. 
 
12 DISEASES AND INJURIES OF THE EAR. 
 
 This bone is all the more likely to move with every 
 motion of the drum-membrane, because its handle is 
 firmly embedded in the dense middle, fibrous layer of 
 the membrana tympani. When the mechanism of the 
 auditory bones, as a whole, is considered, the further 
 advantage of this intimate connection between the 
 hammer-handle and the drum-head will be shown. 
 At the bottom of the auditory canal we find the drum- 
 membrane fixed in a bony ring of its own, about one 
 inch and a quarter from the opening of the external 
 canal in the auricle. Several features at once attract 
 the eye of the observer when a normal drum-membrane 
 is looked at, in its proper position. Its shape is nearly 
 circular; its color is a delicate bluish pearl, except at 
 the white ridge of the handle of the hammer-bone. 
 There is further noticed the peculiar tint obtained by 
 stretching a transparent membrane over a dark cavity. 
 This is due to the fact that the light in the drum-cavity 
 passes first through the drum-membrane from the out- 
 side. It will also be observed that the surface of the 
 drum is smooth and lustrous. This lustre is so great 
 at the lower and front part of the drum that at this 
 point, between the circumference of the membrane and 
 the lower end of the hammer-handle, there is a shining 
 triangular reflection of light. This is called the '' pyra- 
 mid,^^ or "cone of light,^^ and can be seen in any 
 normal ear (Fig. II., 7). There is a prominent point 
 at the upper end of the handle of the hammer, called 
 its short process (Fig. II., 2). This point plays an im- 
 portant part in plotting out the drum-membrane and in 
 getting one's bearings when examining the ear. The 
 short process looks not unlike a small, whitish pimple. 
 
THE DIVISIONS OF THE EAR. 13 
 
 It is situated in the upper periphery of the drum- 
 membrane, at the upper end of the aforesaid white 
 ridge. Two prominent ridges pass from it, one back- 
 ward, the other forward, to the periphery of the drum- 
 membrane, and are called the folds of the membrane 
 (Fig. II., 3, 9). They serve as the upper boundary 
 of the membrane proper, the so-called vibrating mem- 
 brane (membrana vibrans). Above these folds is a part 
 of the drum-membrane in a triangular spot, without 
 any fibrous tissue. This is called the flaccid mem- 
 brane, or membrana flaccida (Fig. II., 1? 1). The neck 
 and head of the hammer-bone lie directly behind this 
 last-named part of the membrane. 
 
 These parts of the hammer bonelet are never visible, 
 however, from without when the ear is in a healthy 
 state. The leverage-line of the hammer lies in the 
 line of these folds. The lower arm of the lever is 
 represented by the handle of the hammer, below the 
 folds, and the short arm, by the neck and head of the 
 same, above the folds. In every vibration of the 
 membrane and bonelets, the malleus, or hammer, 
 swings with a minute excursion about this axis-line, 
 marked by the line of the folds of the membrane. 
 
 The Middle Ear. — The middle ear is the seat of 
 most of the diseases of the ear. Its structure, there- 
 fore, demands a brief consideration. It is composed 
 of the drum-cavity, and two important adjuncts, — viz., 
 the mastoid cells behind, and the Eustachian tube, 
 connecting the ear with the nose, in front. The drum- 
 cavity is the most complicated and delicate of the 
 three portions just named, and is most liable to disease 
 (Fig. I., 4, 5). 
 
 2 
 
14 DISEASES AND INJURIES OF THE EAR. 
 
 Drum-cavity, — This cavity may be described as 
 bounded by four walls, a roof, and a floor. The walls 
 are named the front, the back, the inner, and the outer. 
 The three auditory bonelets are the most important 
 contents of this chamber. It is, however, lined with 
 a most sensitive mucous membrane, which when in- 
 flamed gives rise to excruciating pain. This impor- 
 tant cavity is about half an inch in height and width, 
 and from a twelfth to a sixth of an inch deep, meas- 
 ured from without inward, and lies just beyond the 
 drum-membrane. The mucous membrane which lines 
 it is a continuation of that of the nose and upper part 
 of the throat. This cavity is the true drum, and to it 
 alone the name of drum should be applied. When the 
 name of drum is given to the drum-membrane or drum- 
 head, great confusion arises. 
 
 Auditory Bonelets, — The ossicles of hearing, or audi- 
 tory bonelets, are three in number, — the hammer, or 
 malleus^ the anvil, or incus, and the stirrup, or stapes, 
 named from the fancied resemblance in shape to these 
 implements (Fig. III.). They form the so-called "chain 
 of bones'^ of the ear. Starting from without, the first 
 bonelet is the malleus (Fig. III., 1, 2, 3), the second 
 is the anvil (Fig. III., 4, 5), and the third, the inner- 
 most one, is the stirrup (Fig. III., 6). The first- 
 named is the largest ; the last-named is the smallest ; 
 in fact, it is the smallest bone in the body. 
 
 The hammer is divided into a head, a neck, and a 
 handle. Its length is about a quarter of an inch, one 
 half of which is formed by the handle. The head is 
 about one-eighth of an inch thick. The handle of this 
 bonelet is set into the membrana tympani, and holds it 
 
THE DIVISIONS OF THE EAR. 15 
 
 taut. Besides this support, the hammer is held firmly 
 in position by ligaments which fasten it to the roof and 
 outer wall of the drum-cavity (Fig. I., 4). 
 
 Fig. III. 
 
 The three little bones of the ear, from the right side, in natural con- 
 nection, seen from within. Magnified about four times. (Henle.) 
 1, head of the hammer ; 2, long process of hammer, not found 
 in adults ; 2 a, the short process of the hammer ; 3, the handle 
 {manubrium) of the hammer-bone ; 4, the long limb of the anvil- 
 bone ; 5, its short limb ; 6, the stirrup-bone. 
 
 As we pass inward, next in order comes the anvil. 
 It is divided into a body and two limbs, the horizontal 
 or short one, and the descending or long one. This 
 bonelet, like the hammer, is held to the upper and 
 posterior wall of the drum-cavity by ligaments, and is 
 jointed to the hammer on the outside of its body, and 
 to the stirrup by the tip of its long limb (Fig. III., 4). 
 The joint between the hammer and the anvil has the 
 peculiarity of unlocking or loosening if the hammer is 
 pulled outward, but if the handle is pushed inward, 
 about the axis-line already described (p. 13), this joint 
 between the hammer and the anvil is only the more 
 firmly locked, and the anvil is carried inward towards 
 
1(3 DISEASES AND INJURIES OF THE EAR, 
 
 the inner ear. In fact^ this form of motion occurs with 
 every impression of sound upon the drum and the 
 nerve of hearing. This function in this joint will be 
 found very important when the mechanism of sound 
 and hearing is considered. The action in this joint 
 has been likened to some watch-keys which wind the 
 watch when turned in a certain direction, but when 
 turned in the opposite way unlock the barrel and fail 
 to wind the watch. 
 
 The stirrup is the innermost of the three bones we 
 are considering (Fig. III., 6). It is also the smallest 
 bone in the body, its entire length being one-eighth of 
 an inch. It is divided into a head, a neck, two legs, 
 and a foot-plate. At the junction of the two legs is 
 found the head, in the form of a cup-shaped button. 
 It is designed to receive a knob-like projection on the 
 end of the anviPs long limb. The two legs of the 
 stirrup are made lighter, without being weakened, by a 
 furrowing on their inner surfaces. The foot-plate is 
 ovoid or slightly kidney-shaped, and fits accurately 
 into the oval window of the labyrinth, in the inner 
 wall of the drum-cavity (Fig. I., 9). In this window 
 it is hermetically held by a fibrous packing, as will be 
 further shown. The connection is thus made between 
 the outer ear and the drum-head, on one side, and the 
 labyrinth and the nerve of hearing, on the other. 
 This entire chain of auditory bones moves in and out 
 as a whole, performing a pendulum-like motion about 
 the axis-line in the folds, already described (p. 13). 
 This kind of oscillation, to and fro, on the part of the 
 drum-head and the chain of auditory bones, causes the 
 foot-plate of the stirrup to play backward and forward 
 
THE DIVISIONS OF THE EAR. 17 
 
 in the most minute excursions. This movement of the 
 stirrup, in turn, sets the water in the labyrinth in 
 motion, and impresses the auditory nerve, producing 
 thereby hearing. 
 
 Boundaries of the Drum-cavity, — The dividing par- 
 tition between the drum and the brain is the so-called 
 roof of the drum (Fig. I., 5). This boundary is very 
 thin, and in some individuals has chinks in it. On 
 this account an inflammation in the drum may pass into 
 the brain and prove fatal. 
 
 The front wall of the drum is nearest the throat or 
 nose, and has in it the opening for the reception of the 
 Eustachian tube (Fig. I., 11, 12). On its upper and 
 inner part there is a canal, through which a little muscle 
 passes called the ^^ stretcher of the drum" {tensor tym- 
 pani), on its way across the drum-cavity, to be inserted 
 into the handle of the hammer on its inner and upper 
 part. This muscle is an offshoot from the muscles of 
 the throat and Eustachian tube, and hence sympathizes 
 with their diseases. 
 
 The back wall, like the front, is narrow. It too 
 contains an opening, which communicates with the 
 mastoid cavity and its cells. The topography of the 
 inner and outer walls of the drum or tympanum are 
 more intricate. The outer wall of the drum-cavity is 
 composed mainly of the drum-head. The limit of this 
 wall is the bony ring in which the drum-membrane is 
 stretched (Fig. I., 11). "We have already stated that 
 the hammer-bonelet is closely connected with this wall 
 by its handle (p. 14). An important nerve passes across 
 the inner surface of this wall, near the upper boundary 
 of the drum-membrane. Around this nerve a fold of 
 b 2* 
 
13 DISEASES AND INJURIES OF THE EAR. 
 
 mucous membrane passes, and, standing off a little from 
 the surface of the drum-membrane, forms with it a 
 crease, or groove, opening downward. There are two 
 of these so-called pouches of the drum-membrane, one 
 in front of, and the other behind, the hammer. 
 
 The inner wall of the drum demands close examina- 
 tion. Here we find on the posterior portion the prom- 
 ontory, caused by the outward projection, towards the 
 drum, of the lower turn of the cochlea, yet to be de- 
 scribed. This can often be seen through the drum- 
 membrane, as a pale-yellowish spot. Sometimes the 
 membrane touches the promontory, and in some cases 
 adheres to the inner wall at this point. Above the 
 promontory is the oval window, into which fits the foot- 
 plate of the stirrup-bone (Fig. I., 9). Behind and below 
 the promontory is the round window. A little muscle 
 runs from the head of the stirrup backward to its origin 
 in a hollow pyramid of bone in this inner wall. 
 
 The little oval window is about ^ of an inch in its 
 longest diameter and about ^ of an inch in its shortest. 
 The diameter of the round window is about ^ of an 
 inch. 
 
 Behind the oval window a ridge begins, which marks 
 the course of a bony canal, conveying the facial nerve 
 through the drum to the face. This will account for 
 the fact that inflammation in the ear sometimes pro- 
 duces paralysis of the corresponding side of the face. 
 The ^oor of the drum-cavity is only a narrow groove ; 
 beneath it runs the jugular vein on its way to the lower 
 part of the neck. This accounts for the fact that the 
 movements of the blood in this vein sometimes cause 
 abnormal sounds in the ears. 
 
THE DIVISIONS OF THE EAR. I9 
 
 Eustaehian Tube, — This tube, or canal, forms the 
 only aerial communication between the nose and the 
 ear (Fig. IV.)- It opens near the posterior nostril in 
 the upper part of the throat, behind and above the 
 palate. Its course is upward, outward, and backward 
 towards the drum. In the pharynx or upper throat 
 the opening of this tube is wide (Fig. I., 13). It then 
 
 Transverse section through the Eustachian tube. Magnified about 
 four times. (Henle.) 1, cartilaginous upper and back wall; 
 2, the cavity of the tube proper; 3, the front wall composed 
 chiefly of muscle ; 4, the hook-shaped part of the upper wall, 
 curving forward to join the muscular wall. This hook-shaped 
 part moves with the muscles in every act of swallowing, and 
 aids in widening the cavity, 2, through which air passes to the 
 inside of the drum. 
 
 narrows to what is called the isthmus (Fig. I., 12), 
 from which it widens again to the tympanic cavity. 
 The entire length of this tube is a little more than an 
 inch. Two-thirds of the tube is cartilage ; the other 
 third is bone. It is lined with mucous membrane, 
 continuous with that of the throat, nose, and drum- 
 cavity. Hence diseases pass readily from the nose and 
 throat to the ear. 
 
20 DISEASES AND INJURIES OF THE EAR. 
 
 This tube is provided with muscles which arise from 
 the palate and are attached to its cartilaginous part. 
 When these are moved in swallowing they draw the 
 cartilaginous walls of the Eustachian tube apart and 
 allow air to enter the drum-cavity. This is necessary 
 for the healthy action of the ear. If it is deprived of 
 air for any length of time, deafness and earache set in. 
 
 Mastoid Cells. — The last division of the middle ear 
 which claims attention is the mastoid portion, with its 
 peculiar cells. This is located behind the ear, in a 
 rounded prominence easily felt by all. It is filled with 
 a number of small bony cells, hollow, containing air, 
 and lined by mucous membrane. One large one is 
 situated at the opening into the drum-cavity. This is 
 called the antrum^ or cave. It is often the seat of dis- 
 ease, which we shall consider later. 
 
 The Internal Ear. — The internal ear is also called 
 the labyrinth. It is composed of the vestibule in the 
 middle, the cochlea in front, and the semicircular canals 
 behind (Fig. I., 6, 10). It is a hollow bony cavity, 
 containing soft tissues of a similar shape, also hollow, 
 and receives the expansion of the auditory nerve. The 
 oval window, already alluded to (p. 18), is in the 
 vestibule. Through this window by means of the foot- 
 plate of the stirrup-bone (Fig. I., 9) pass the waves of 
 sound in normal hearing, on the way to the auditory 
 nerve. The vestibule-cavity is pear-shape. It is about 
 \ of an inch wide from within outward, and a little 
 more than -^ of an inch measured from front to back. 
 Its four walls run together where the cochlea begins. 
 This latter cavity, as its name implies, is shaped like 
 a snail-shell. It is, in fact, a bony canal wound two 
 
THE DIVISIONS OF THE EAR. 21 
 
 and a half times about a bony pillow (Fig. I., 10). 
 This canal of the cochlea is partly divided longitudi- 
 nally by a bony shelf, which partition is completed by 
 a membrane. Thus we find the cochlear canal divided 
 into two smaller canals, or stairways as they are 
 termed. They are joined together at the top of the 
 shell, at the cupola. 
 
 The canal of the cochlea being divided into two 
 passage-ways, one can imagine one's self entering the 
 upper passage from the vestibule, and emerging at last 
 by the lower one at the round window. This latter 
 window is closed by a membrane, which shuts it off 
 from the drum-cavity. 
 
 When the fluid which fills the vestibule and entire 
 labyrinth is pressed upon by the foot-plate of the 
 stirrup, in the oval window, it finds relief at the round 
 window by the yielding of the aforesaid membrane. 
 
 The semicircular canals, three in number, communi- 
 cate with the back part of the vestibule (see Fig. I., 6). 
 Thus we complete the sketch of the bony labyrinth. 
 This is a hollow cavity, and, in its normal condition, 
 filled with water. In this are supported delicate soft 
 structures similar in outline and shape to the bony case 
 containing them, and hence called the membranous 
 labyrinth. They may be considered hollow casts of 
 the bony labyrinth. They contain in their soft and 
 delicate cavities the terminal nerve-branches of the 
 acoustic nerve. 
 
 Membranous Labyrinth, — Within the vestibule, al- 
 ready described, are found two little sacs, the round 
 and the elliptic, which may be regarded as the central 
 part of the membranous labyrinth. The elliptic is the 
 
22 DISEASES AND INJURIES OF THE EAR. 
 
 larger, and with it unite the membranous semicircular 
 canals. It is joined to the round sac by means of a 
 V-shaped canal. The round sac unites with the 
 cochlea. Hence the membranous labyrinth, like the 
 
 1 
 
 A diagrammatic representation of Corti's organ, the ultimate distribution of 
 the auditory nerve in the internal ear. Magnified between 300-400 times. 1, 
 the base of the inner hairy cells : auditory nerve passing between them ; 
 2, section of a blood-vessel; 3 and 5, the basilar membrane, uniting the 
 edge of the bony shelf at 1 with the outer wall of the cochlea at 6, thus 
 dividing the cochlear canal into A, the vestibular scala, and C, the tym- 
 panic scala ; 8, the outer pillar of Corti leaning against 9, the inner pillar 
 forming Corti's arch ; 4, outer hairy cells, receiving nerve-filaments from 
 14, the nerve of hearing; 7, upper ends of haired cells where the acoustic 
 hairs are found ; 10, upper ends of inner haired cells ; 11, Corti's membrane ; 
 12, upper lip of bony shelf: the nerve of hearing, 14, runs through lower 
 part of this shelf, emerging at 1, in the lower lip of bone. Corti's organ 
 may be said to lie between the lines 5 and 12. 
 
 bony case containing it, is in reality one cavity. It 
 lies in water, and is also filled with it. This labyrinth- 
 water is part of the natural water of the brain and 
 skull-cavity. The vestibular branch of the auditory 
 nerve supplies branches to all soft parts in the vesti- 
 bule and membranous semicircular canals, and the 
 cochlear nerve supplies the soft tissues in the cochlea. 
 
THE DIVISIONS OF THE EAR, 23 
 
 It may be of interest to the reader to trace the 
 course of the nerve of hearing in its distribution to 
 the cochlea. 
 
 Cochlear Nerve and CorWs Organ. — The cochlear 
 nerve, after entering the base of the bony pillar 
 around which the cochlear canal is twined, emerges on 
 the bony shelf of the canal, and is spread out over the 
 latter, like a fringe. Let us trace one filament of this 
 nerve on its way over this shelf and to its terminus, 
 the so-called organ of Corti. The latter is simply a 
 support, and not a percipient organ. It consists of 
 two pillars placed on the membranous partition be- 
 tween the two cochlear stairways (see Fig. Y., B, C). 
 These pillars lean towards each other and are united 
 above, forming a so-called arch of Corti. A delicate 
 net-work, running parallel to the membranous partition 
 above named, is supported by this arch. In this net- 
 work are held a series of cells or disks, with fine hairs 
 on their upper ends. To these cells, named hair-cells, 
 the nerve passes and is attached, as its ultimate desti- 
 nation (see Fig. V., 7, 14). 
 
 There are three thousand of these organs, or arches 
 of Corti, in the human ear 
 
24 DISEASES AND INJURIES OF THE EAR. 
 
 CHAPTER 11. 
 
 PHYSIOLOGY OF THE EAR. 
 
 Sound. 
 
 Sound is motion imparted to the auditory nerve. 
 The motion productive of sound is usually conveyed 
 by undulations in the air. A sounding body commu- 
 nicates shocks to the surrounding atmosphere, which 
 pass by waves of undulation, as they are called, on all 
 sides which are free, as the waves ripple the surface 
 of water after it is disturbed by a pebble thrown into 
 it. Sound moves at the rate of 1090 feet per second 
 in air at the freezing-point. The velocity increases two 
 feet per second for each increment of 2° Centigrade, 
 in temperature. Let us assume that water represents 
 the atmosphere, the pebble the source of sound in 
 the vibrating body, the ripples on the surface of the 
 pond the waves of sound in the air, and then the 
 shore of the pool will represent the ear, or the point 
 where sound is received. The perception by the ear 
 of these motions or vibrations in the atmosphere is 
 hearing. 
 
 Intensity of sound depends on the breadth of these 
 waves ; pitch depends upon their number in a second ; 
 and quality (clang-tint, or timbre) depends upon the 
 peculiarity and manner of the occurrence of the sound. 
 Partial tones, so called, compose a sound, just as ordi- 
 nary light is composed of several colors. The dif- 
 ference in sounds depends upon the number and strength 
 
PHYSIOLOGY OF THE EAR. 25 
 
 of these partial tones. Thus it is that one voice differs 
 from another. The first partial tone is called the 
 fundamental note ; the others are called the harmonics 
 or '' over-tones,^' 
 
 Ordinary musical tones, like notes of the piano or 
 organ, vary from 33 to 3960 vibrations in a second. 
 Some pianos give out notes of as many as 4224 vibra- 
 tions in a second. A shrill note, like that of the 
 piccolo, a kind of flute, contains 4752 vibrations in a 
 second. This is the ordinary range in the musical 
 scale ; but the human ear recognizes as musical notes 
 those as low as 20 vibrations or as high as 38,000 
 vibrations in a second. The high notes are painful to 
 the ear, because they set up a powerful sympathetic 
 resonance in the air of the auditory canal. When 
 waves of sound are thrown back to their source, we 
 have echo. If we observe the surface of a pool thrown 
 into waves by a pebble, we will see some of the waves 
 apparently going back to the point of starting, thus 
 representing echo. 
 
 When waves of sound occur with regular intervals 
 between them, they produce music. When these occur 
 with irregularity, they produce discord, or noise. 
 
 Hearing, — When a wave of sound reaches the side 
 of the head, part of it is received by the auricle and 
 directed down the auditory canal to the drum. The 
 latter is thrown into pendulum-like, or to-and-fro, 
 vibrations by the wave of sound. This motion is im- 
 parted by the drum-membrane to the hammer-bonelet 
 and the other ossicles, and these are made to swing in 
 and out. Thus the little foot-plate of the stirrup-bone, 
 
 in the oval window of the vestibule (Fig. L, 9), is 
 B 3 
 
26 DISEASES AND INJURIES OF THE EAR, 
 
 made to play in and out and to impress the water of 
 the labyrinth. This in turn conveys the impression 
 of the movement of the ossicles to the nerve-filaments 
 in the labyrinth, and the brain interprets these motions 
 as sound. 
 
 Function of the Auricle. — The auricle acts as a col- 
 lector of sound in the lower mammals. Here in them 
 are found well-developed muscles, and the auricle is 
 consequently very movable in animals like the horse, 
 the cow, or the rabbit. In these animals the auricle is 
 very movable in all directions, which enables them to 
 catch sounds from all quarters, especially from before 
 and from behind. This is especially valuable to grass- 
 eating animals when in a wild state, as it enables them 
 to hear the approach of flesh-eating beasts in pursuit 
 of them. In the flesh-eaters, like cats, tigers, etc., the 
 auricle is pointed rather forward than backward, and 
 is more easily kept in that position than in any other. 
 As their prey is generally ahead of them, this position 
 of the auricle enables the pursuer to hear where the 
 pursued is. 
 
 In aquatic mammals the auricle is very small, but is 
 very useful, as it can be tightly drawn inward into the 
 mouth of the auditory canal and keep the water from 
 entering the ears during their submergence in water. 
 We are taught by this fact in natural history that 
 mammals or warm-blooded animals, including man, 
 should not get cold water in their ears when bathing 
 at any time. 
 
 In man the auricle is immovable, so that he is not 
 supplied with any natural means of keeping water out 
 of his ears when he is under water. This I take to 
 
PHYSIOLOGY OF THE EAR. 27 
 
 be an indication that man is not intended to expose his 
 drum to the contact of cold water. 
 
 Although the auricle in man cannot be regarded as 
 a movable collector of sound, it cannot be regarded 
 as entirely useless as an aid to hearing, since by its 
 shallow, trumpet- mouth shape it acts as a collector or 
 strengtheuer of some of the weaker sounds fallino; on 
 it. The auricle has no part in the quantitative con- 
 veyance of sound, but it may be regarded as having a 
 decided effect in the qualitative sensation of sound as 
 perceived by the human ear. Any one may convince 
 himself of this when in the presence of a multitude 
 of sounds, such as occur by the sea, near escaping steam, 
 or in a grove of trees with rustling leaves. If when 
 in these sounds the auricle is gently pressed forward 
 or firmly backward against the side of the head, in 
 the first instance all the sounds are fuller and deeper. 
 Hence a deaf man instinctively puts his hand behind 
 and around his auricle, to enable him to hear all sounds 
 better. In the second condition the deeper sounds will 
 seem to vanish or be quieter, while the fainter ones, 
 those of higher pitch, will become more prominent. 
 This is due to the composite nature of all sounds and 
 the power the auricle has by nature to strengthen by 
 resonance the component or ^^ partial'^ tones of any 
 sound. 
 
 Auditory Canal. — The tube of the trumpet of which 
 the auricle is the mouth is represented by the auditory 
 canal. The length of the latter, plus the depth of the 
 auricle, is just the proper length to resound to the tones 
 of the human voice most important for us to hear. 
 
 In addition to these resonant functions, the human 
 
28 DISEASES AND INJURIES OF THE EAR, 
 
 auditory canal has the ability to expel the surplus ear- 
 wax which forms in it. As already stated, the wax- 
 glands of the ear lie near the mouth of the passage. 
 From that point inward the walls of the canal are 
 slightly convergent to the middle part of the canal. 
 Here the canal widens again towards the drum, as the 
 shape of the auditory canal is that of two detruncated 
 cones placed together at the point where their apices 
 are cut off. This makes the narrowest part of the 
 canal in the middle, and the wide ends at the opening, 
 and where the drum-membrane is stretched. From 
 the central narrow point the outer part of the canal 
 inclines outward and down-hill on its floor, while the 
 inner part inclines similarly towards the drum. A 
 ball of wax, therefore, in the outer end of the canal 
 would roll outward if let alone. As wax is formed in 
 this outer part of the canal, it will not get beyond the 
 isthmus of the canal unless forced there by artificial 
 means. Again, ear-wax will tend to come from the 
 ear, rather than go farther into it, because the skin 
 over the drum-head and the walls of the auditory 
 canal grows outward towards the external mouth of 
 the canal, and carries with it, just as a finger-nail carries 
 a spot with it, as it grows, until the ear-wax, etc., ap- 
 pears at the external opening of the ear. It is to be 
 regretted that this beneficent process of nature is con- 
 stantly interfered with" by the useless endeavors to swab 
 or pick the ear in order to free it from w^ax. 
 
 Membrana Tympanic or Drum-head. — The function 
 of the drum-membrane is to collect sound-waves, to 
 convey their force to the chain of little bones in the 
 middle ear, and to support and help keep the hammer- 
 
PHYSIOLOGY OF THE EAR. 09 
 
 bone in proper position^ and by that means the other 
 two bonelets, so that they will all swing easily with 
 every wave of sound. Another function is to protect 
 the mucous membrane in the middle ear from the 
 direct contact of the external air. 
 
 If the membrana tympani is pressed too far either 
 way, the chain of little bones cannot swing properly, 
 and hence sound is no longer transmitted normally. 
 Thus, if the bones are pressed inward upon one an- 
 other, they become so locked as not to oscillate freely. 
 If, on the other hand, the drum-membrane is forced 
 outward, the malleus (hammer) is carried outward, and 
 a partial dislocation occurs between it and the incus, or 
 anvil. Hence sounds cannot be transmitted over the 
 imperfect chain. In either case the conductors of sound 
 are said to be out of equilibrium. When a large per- 
 foration occurs in the drum, there is a consequent loss 
 of outward traction on the part of this membrane. 
 Hence the balance of power betw^een the membrana 
 tympani and the stretcher muscle of the drum is de- 
 stroyed, and the latter drags the chain of bonelets too 
 far inward. Hearing is then impaired, because the 
 bonelets are then locked upon one another and are un- 
 able to vibrate and conduct sound properly. 
 
 When the drum-membrane is perforated, the mucous 
 membrane of the drum-cavity is exposed to the action 
 of the external air. Hence when a sudden perforation 
 occurs from violence or accident to the membrana, srreat 
 care should be taken not to pour or drop anything into 
 the external ear. The best protection in such a case is 
 a little cotton laid in the external opening of the audi- 
 tory canal. 
 
 3* 
 
30 DISEASES AND INJURIES OF THE EAR. 
 
 The intact drum-membrane prevents the entrance 
 of an insect or the like into the head. Hence no alarm 
 need be felt that any foreign substance which has got 
 into the external canal may advance farther and reach 
 the brain. This is impossible, as the drum-head is 
 stretched across the inner end of the auditory canal to 
 prevent such an accident. Furthermore, if the mem- 
 brana tympani should be perforated, a foreign substance 
 might get into the middle ear, but not into the brain, 
 as the latter lies beyond the drum-cavity and separated 
 from it by a wall of bone. We shall show farther on 
 that when disease in the middle ear destroys this bony 
 wall between it and the brain, then the latter may 
 become diseased from the encroachment of the aural 
 disease. 
 
 Tympanic Cavity.— The tympanic or drum cavity 
 acts as an air-chamber, over one side of which is 
 stretched the drum-membrane. The arrangement is 
 analogous to that in the musician's drum : in both it 
 and the tympanic cavity, or ear-drum, there is found a 
 membrane stretched over a hollow box, to which air 
 has free access by means of an opening on one side. 
 In the musical instrument air enters by a little hole on 
 one side ; in the ear air enters the drum-cavity by the 
 Eustachian tube. If in either case the air-passage is 
 closed, the external atmosphere forces the drum-mem- 
 brane inward, and a quasi-vacuum is formed in the 
 human ear by the absorption of the atmosphere pre- 
 viously in it. As the drum-head sinks in, the ossicles 
 follow inward, the chain of bonelets is locked, and 
 deafness ensues. 
 
 Eustachian Tube. — The front wall of the Eustachian 
 
PHYSIOLOGY OF THE EAR. 31 
 
 tube is drawn away from the back wall, and the air 
 enters the thus opened tube with every act of swallow- 
 ing. By this means an equilibrium of air is main- 
 tained on both sides of the drum-membrane. Did such 
 renewal of air in the drum-cavity not take place fre- 
 quently, deafness would soon occur, from the absorption 
 of the air in the drum, and the membrane and bonelets 
 would be locked, and cease to vibrate. Sudden closure 
 of the Eustachian tube, and a consequent defective 
 ventilation in the middle ear, occur not unfrequently 
 in children, from cold in the head, causing earache 
 from the inward pressure of the drum-membrane. 
 The Eustachian tube acts like a safety-tube when the 
 drum- membrane is forced suddenly inward by concus- 
 sion from a blow on the ear, or from an explosion. 
 The air of the drum-cavity is then forced into the 
 Eustachian tube, and thence into the throat, thus 
 allowing the drum-head to recoil enough to save it 
 from rupture. Did it not thus yield, it would be torn 
 by the concussion and compression of the air in the 
 auditory canal. 
 
 Mastoid Cells. — The acoustic advantages of the com- 
 munication of the mastoid cells with the middle ear 
 can be appreciated by considering some of the physio- 
 logical features of the middle ear. Sound-waves will 
 produce the best effect when in the middle ear the 
 following three conditions are maintained : 
 
 1. The Eustachian tube must remain closed most of 
 the time. 
 
 2. This tube, however, must be opened sometimes 
 for ventilating the middle ear ; and this occurs at each 
 act of swallowing. 
 
32 DISEASES AND INJURIES OF THE EAR. 
 
 3. The cavity of the drum — the tympanum — must 
 be in communication with large irregular air-cavities, 
 for resonant purposes. This is obtained by its connec- 
 tion with the irregular, honey-comb cells of the mastoid 
 bone. Were the drum-cavity larger and of a regular 
 outline or shape, it would be useless acoustically, from 
 its consequently great resonance. 
 
 INTERNAL EAR. 
 
 The internal ear is an organ in a bony case, filled 
 with water. In this fluid the membranous parts and 
 nerve of hearing float, with but slight attachment. 
 The internal ear is comprised within the so-called 
 labyrinth (see p. 20). We may liken the labyrinth in 
 its practical construction — not in outline — to a water- 
 tight keg lying on its side. On the side of this sup- 
 posed keg, towards us, we shall find an oval hole her- 
 metically closed by a leather patch, and, in the left 
 ear, to the right of this oval window, there will be 
 found a round hole, also hermetically closed by a 
 membranous patch. At these two points in this cavity 
 containing water, two spots will be found which will 
 slightly yield to pressure, either from within or without. 
 Hence, if one of these points is pressed inward, the 
 water beyond it will force the other one outward cor- 
 respondingly. Just this condition of compensatory 
 yielding is found in the oval and round windows of 
 the labyrinth. 
 
 The stirrup-bonelet fits into the oval window, cor- 
 responding to the oval hole just described as in the 
 water-tight keg. 
 
 Inward pressure of the stirrup, as occurs with every 
 
PHYSIOLOGY OF THE EAR, 33 
 
 sound falling on the ear, is communicated to the laby- 
 rinth-water, which is thrown into motion because of 
 the yielding point at the membrane of the round win- 
 dow. Did this yielding at the round window not 
 occur, the inward pressure of the stirrup would so 
 compress the fluid in the labyrinth as to injure the 
 delicate nerve of hearing contained therein. 
 
 Vestibule and Semicircular Canals, — It has often been 
 supposed by leading physiologists that we hear noises 
 with the vestibule-nerves, and music with nerve-struct- 
 ures in the cochlea. It would seem that all hearing 
 is brought about by means of the vibration of minute 
 cells supplied with short hairs, in communication with 
 the branches of the nerve in the internal ear. Hensen 
 and Ranke, two German observers, examined certain 
 marine animals with transparent bodies. The micro- 
 scope revealed in these animals not only curious cells 
 tufted with stiiF, vibratile hairs, in connection with the 
 nervous structures of the ear, resembling those in man, 
 but it was also observed that these stiff hairs vibrate 
 when certain musical notes are sounded near them. 
 
 Therefore, in all probability, the most sensitive parts 
 of the internal ear are these stiff-haired cells, each one 
 of which would seem to be specially endowed with the 
 ability to respond to, or vibrate in consonance with, the 
 various sounds and notes which fall on the ear. Such 
 cells are specially numerous in the cochlea, the entire 
 arrangement of which seems to favor the mechanical 
 support of these delicate and important bodies. 
 
 The physiology of the semicircular canals is not 
 positively known. It is, however, pretty well estab- 
 lished now that these canals are endowed with a peculiar 
 
34 DISEASES AND INJURIES OF THE EAR, 
 
 sensibility as to the position of the head and body. 
 Hence it may be said that the sense of equilibrium, or 
 proper carriage of the body, lies in them. It is well 
 known that when these canals are wounded or de- 
 stroyed in birds or other animals, they no longer are 
 able to control the movements of their bodies in their 
 attempts at flying or walking. Then there occur pe- 
 culiar reeling and falling symptoms, without loss of 
 consciousness. Since, with certain symptoms of ear- 
 disease in man, there ensue at times just such peculiar 
 reelings and falls, without unconsciousness, it is sup- 
 posed that in such cases the semicircular canals are 
 the seat of disease. Therefore some locate a sense of 
 equilibrium in these canals in the back part of the 
 labyrinth. 
 
PART II. 
 
 COMMON DISEASES AND INJURIES OF THE EAR: THEIR 
 PREVENTION AND CURE. 
 
 CHAPTER I. 
 
 DISEASES AKD INJURIES OF THE EXTERNAL EAR. 
 
 Diseases of the Aitricle, 
 
 In very cold weather the auricle is liable to be 
 frost-bitten when exposed to a low temperature^ as in 
 sleighing, driving, skating, or working in the open air. 
 This is not dangerous either to health or hearing, but 
 it may be painful, when the blood once more circulates 
 in the skin, and, if improperly managed, some distortion 
 and disfigurement may ensue in the auricle. The auricle 
 when frost-bitten becomes white, stiff, and brittle. Great 
 care must be taken not to break it, nor to heat it too 
 quickly. It should be gently rubbed or chafed with 
 cold water, snow, or ice, in a cool room, and thus the 
 circulation of the blood slowly restored in the frozen 
 ear. If heat is suddenly applied, inflammation may 
 set in, and the ear will be as though it were burnt. 
 The best plan, therefore, is to apply cold to the frozen 
 skin until it begins to have feeling in it once more, 
 and then the ear is safe. 
 
 Prevention of Frost-bites. — To prevent frost-bites in 
 
 35 
 
36 DISEASES AND INJURIES OF THE EAR, 
 
 the future, after the auricle has been thus once attacked, 
 requires a course of treatment which will harden the 
 skin previously affected by freezing. After the skin 
 has healed, it may be made harder, and more resistant 
 to freezing again, by bathing the once-inflamed part 
 with alum-water, ten to twenty grains to the ounce of 
 water. Oil of cubebs may be used in the same way, 
 but the odor of this will often preclude its employment. 
 The oil of sassafras, cloves, or mint, in the strength of 
 ten to fifteen drops to the ounce of vaseline, or albolene 
 ointment, will also act well as a stimulating applica- 
 tion. If care is taken not to expose the once-frozen 
 auricle to great cold, after recovery, and some means 
 resorted to to make the skin of the affected part harder, 
 in the following winter, with ordinary care, no freezing 
 will occur. But it will always be safe to make some 
 strengthening application to the skin at night before 
 retiring, as cold weather comes on, the winter following 
 the original frost-bite. 
 
 The cartilage of the auricle may be broken by a 
 blow on the ear, or such violence may so loosen the 
 covering of the cartilage beneath the skin as to permit 
 blood to get under it. This may be absorbed again if 
 let alone, or properly treated, but in any case the 
 wound may heal with great puckering of the skin of 
 the ear, and the auricle will become greatly disfigured. 
 This is sometimes seen in pugilists and in the insane, 
 as the result of violent blows or falls in which the ear 
 is injured. In the insane it has been considered by 
 some authorities to be a symptom of their brain-disease, 
 which being attended with debility, weakening of the 
 tissues of the body, and defective circulation of the 
 
DISEASES AND INJURIES OF EXTERNAL EAR. 37 
 
 blood, the latter escapes from its vessels not only in the 
 brain, but also upon the surface of the body. It is 
 held by some that this blood-tumor or sac of blood in 
 the auricle sometimes forms spontaneously in the insane, 
 and is then a diversion of blood from the brain, and 
 as such saves the life of the lunatic for the time being. 
 
 Hsematoma auris, as this blood-tumor of the auricle 
 is called, may originate not only from wounds or inju- 
 ries inflicted by one person upon another, but careless- 
 ness regarding the protection and posture of the ear in 
 winter-time, may lead to the formation of an othaemo- 
 toma on the auricle from being frozen and then roughly 
 handled. 
 
 Eau, a German writer on diseases of the ear, gives 
 an account of a man who fell asleep with his auricle 
 against the window-pane of a railway-car, while travel- 
 ling during a very cold night, in an unheated car. In 
 the morning when he awoke his ear was frozen fast to 
 the window-pane ; but before he was fully aware of 
 the accident he pulled his head away from the window, 
 and in so doing tore the adherent ear very badly. 
 This led to a traumatic blood-tumor, and subsequent 
 deformity of the auricle. A very good suggestion has 
 been made by Dr. C. J. Blake, of Boston, to apply mas- 
 sage in the treatment of these blood-sacs forming in the 
 auricle. The gentle kneading and rubbing thus ap- 
 plied leads to an absorption of the extravasated blood, 
 and all risks, arising from an opening of the sac with a 
 knife, are avoided. Deformity, too, of the ear is much 
 less likely to occur if massage is used and the sac is 
 unopened. 
 
 Ear-7'ings, — In piercing the lobule of the ear for 
 
 4 
 
38 DISEASES AND INJURIES OF THE EAR. 
 
 wearing ear-rings^ the cartilage, which sometimes dips 
 into this fatty aj)pendage, is wounded. Great care, there- 
 fore, should be exercised, when the lobe is to be pierced, 
 not to make the perforation high enough to strike the 
 cartilage. This can be avoided by feeling for the car- 
 tilage in the lobule. If present, it will reveal itself 
 by its hardness. It would be better not to pierce the 
 ears at all for ear-rings ; but if it is done it should be 
 with these precautions. 
 
 Cleft Lobule, — Ear-rings are sometimes dragged open, 
 either accidentally in play or intentionally in quarrels. 
 By this means they are torn through the soft lobule, 
 w^hich is left with an unsightly slit. This, however, 
 can be removed by an operation and subsequent proper 
 treatment. 
 
 Imperfect Development — Children are sometimes born 
 without auricles, or they may be born with several 
 auricles. Some of these may be placed low down on 
 the neck, or in front of the usual place. They are 
 generally small, or, as it is termed, rudimentary. 
 Sometimes the auricle is only partially developed. 
 Yet with all of these defects or peculiarities the hearing 
 may be good. 
 
 If these defects, however, extend into the auditory 
 canal or middle ear, then the hearing is found defec- 
 tive. There is one peculiar defect sometimes found 
 in children in front of the ear, at the union with the 
 cheek. This is a small hole communicating with a 
 canal leading into the middle ear, or the throat. This 
 is called a congenital fistula of the ear. It has no 
 effect on hearing, and generally closes in adult life. 
 
 f)kin-Diseases. — There are numerous diseases of the 
 
DISEASES AND INJURIES OF EXTERNAL EAR. 39 
 
 skin wliich may affect the auricle, — viz., chafing, sun- 
 burn, poison from plants or insects, erysipelas, eczema, 
 boils, syphilitic eruptions, shingles (herpes zoster), and 
 cancer. Many of these do not demand much treatment, 
 and are easily cured, but none should be neglected. 
 The graver ones should instantly receive treatment. 
 It should always be borne in mind that whatever drug 
 is put on the auricle should not be allowed to run 
 farther into the ear, for fear of injuring the drum. 
 
 Sunburn of the auricle may be treated with appli- 
 cations of cosmoline, vaseline, or albolene. Erysipelas 
 may receive a similar local treatment, but, in addition, 
 internal treatment will be needed. Boils in the auricle 
 at the mouth of the auditory canal are extremely pain- 
 ful. They may be relieved by applications of small 
 pledgets of cotton soaked with glycerin and water, in 
 equal parts, or with a solution of ichthyol (10 per cent.) 
 on cotton. Eczema of the ear demands very careful 
 treatment. The burning can be relieved in the early 
 stages by the application of oxide of zinc ointment, or 
 by dusting powdered starch over the weeping surface 
 of the sore skin. Syphilitic eruptions, shingles, and 
 cancer must receive attention from a medical attendant. 
 
 Hygiene, and Avoidance of Disease, — It will be found 
 that generally there is either too much toilet of the 
 ears, or improper care and protection are bestowed on 
 them. Again, there is found great neglect even in 
 health, so that the organs are unduly exposed to stormy 
 weather and cold water. Disease is thus often pro- 
 duced in organs which might otherwise have remained 
 good ears. Thus, the auricle, or outside ear, should 
 get moderate and gentle washing with a wash-cloth in 
 
40 DISEASES AND INJURIES OF THE EAR, 
 
 preference to a sponge^ and then receive a gentle and 
 thorough drying. The auricle should never be rubbed 
 hard^ or dragged or pulled upon in any way. 
 
 When it is desirable to protect the ears from cold 
 air, it should be done by placing over them a covering 
 sitting lightly on them, and not one which would bind 
 them close to the head. A light loose cap will protect 
 the auricle and the bald heads of infants. But a tight 
 cap may do harm to their ears, by binding them too 
 firmly and closely to the side of the head. This causes 
 increased perspiration behind their ears, with macera- 
 tion of the skin at that point, and a disease like '' milk 
 crust^^ may be started. 
 
 The simplest soaps are the best to use about the ears, 
 not only of infants, but of adults, A good soap is 
 hard to find. A little Castile soap (the French make) 
 is safe. It is desirable to obtain a bland soap, not too 
 alkaline, and one free from high perfume, as highly- 
 scented soaps are most apt to sour on the skin after 
 using them. As a rule, children's ears are not only 
 washed too much, but they are rudely and painfully 
 washed, especially by dragging on the auricle and 
 boring or swabbing in the mouth of the auditory canal. 
 Washing in this part of the body must be done gently. 
 
 If it is desirable to protect the ears from cold, a light 
 ear-muflp or a veil can be placed about the face and 
 ears, or the ear-pieces from a cap, or a woollen scarf 
 will afford ample protection, in children. Adults can 
 employ ear- muffs or coverings similar to the above for 
 protection of their auricles. If pain is felt deeper in 
 the ears on going into the open air, a piece of cotton 
 may be laid lightly in the mouth of the auditory canal, 
 
DISEASES AND INJURIES OF EXTERNAL EAR. 41 
 
 if there is no discharge from the ear, at the same time. 
 In no case should cotton be worn in the ears in the 
 house. 
 
 The ears must sometimes be protected from the sun. 
 This can be done by wearing a hat with a broad brim, 
 or by a light cape falling from the cap, as in the so- 
 called ^^ havelock.^^ This will also protect the ears 
 from the sting of insects. If this cape should be too 
 warm, — as it may be in lands where most needed, — a 
 light veil or net suspended in the same way will answer 
 a better purpose. 
 
 I must here speak a word of condemnation against a 
 most reprehensible method of pulling children's ears, 
 in punishment. Although this is not as dangerous to 
 hearing as '' boxing the ears,'' as will be shown here- 
 after, yet it may injure the drum, because some of the 
 tissues of the auricle and canal are connected anatomi- 
 cally as deep as the drum, as shown by recent inves- 
 tigations of Sexton and Pinkerton, of New York. 
 Nevertheless, the practice must be condemned as cruel 
 and likely to drag so strongly on the ligaments holding 
 the auricle in place as to cause inflammation at the root 
 of the ear. If this inflammation should not be promptly 
 checked, it could lead to permanent hardness of hearing 
 by spreading down to the drum. Aside from the danger 
 to hearing which might accrue, the bone underlying 
 these inflamed fibrous ligaments of the auricle may be- 
 come affected, and the inflammation from this spread 
 to the brain, which lies just beyond the bone thus 
 diseased. 
 
 In performing ordinary toilet, the auricle is often 
 subjected to considerable roughness in washing it. As 
 
 4* 
 
42 DISEASES AND INJURIES OF THE EAR. 
 
 inflammation and boils can be thus excited in the 
 auricle^ such rough manipulation should be avoided, 
 especially as it is not necessary for cleaning the ear. 
 The auricle should be carefully dried after it is washed, 
 and also the hair and the parts of the scalp behind and 
 around it. This is especially necessary, since if any 
 dampness is allowed to remain in or near the auricle, 
 evaporation goes on, and, the temperature of the ear 
 being thus reduced, cold is taken and the ear may be- 
 come the seat of catarrh. Hence the popular notion 
 that dashincr cold water ao^ainst the side of the head 
 and into the auricle is strengthening or hardening to 
 the ear, rendering it resistant to cold, is erroneous. 
 There is also a silly form of play consisting in lifting 
 a little child by the head, placing the hands against or 
 over the auricles. In this act the auricles are unduly 
 dragged upon, and may be injured. In any case, a 
 sudden jerk or turn of the child might break its neck. 
 Hence, for all reasons, such forms of play should be 
 most strenuously discountenanced. 
 
 DISEASES OF THE AUDITORY CANAL. 
 
 Foreign Bodies in the Ear. — Children are more likely 
 to get inanimate foreign substances in their ears than 
 adults, because the former put them in the ear in play, 
 or one child puts something into the ear of another in 
 rude playfulness. Adults are more likely to get living 
 insects in their ears, from sleeping on floors of shops 
 and bakeries, and in dirty beds, etc. 
 
 Let it be said at the outset of this subject that any- 
 thing that can get into the ear can be removed if proper 
 attempts are made. It may not be easy, however, for 
 
DISEASES AND INJURIES OF EXTERNAL EAR, 43 
 
 any one but a specialist to make these endeavors. The 
 friends of a child who has got something in its ear may 
 be consoled by the fact that no bead, button, or grain 
 of corn, etc., which the child has put in the ear, will 
 do harm, if let alone by every one but a skilled surgeon, 
 supplied with proper means of illuminating the affected 
 ear for examination, and suitable instruments for treat- 
 ment. When a child, therefore, gets something in its 
 ear, rest assured that it has not gone beyond the reach 
 of surgical skill. It cannot work its way into the 
 brain, as many think. The harm which has often 
 followed the simple insertion of a foreign substance 
 into the ear has been entirely due to the utterly igno- 
 rant and unskilful efforts at getting it out. These 
 have often pushed the foreign object farther into the 
 ear, ruptured the drum, set up inflammation of the ear, 
 and, in some cases, even of the brain, followed by 
 death. A rough and careless probing, or awkward 
 hooking and scraping, to get hold of the object gen- 
 erally fails to extract the object, but most surely wounds 
 and injures the delicate parts in the ear. Sometimes 
 the pain thus caused by rude efforts to extract the 
 foreign body from the ear is supposed to be due to the 
 presence of the offending substance, and therefore leads 
 to renewed efforts at its extraction. This only aggra- 
 vates matters, until the drum is often entirely destroyed, 
 while the foreign substance eludes these rude endeavors 
 to extract it. 
 
 Not long ago the writer was consulted by a man who 
 stated that some mud had been splashed in his ear, and 
 that his companions in a machine-shop had tried to 
 remove the mud with bits of wire and small tools. 
 
44 DISEASES ASD INJURIES OF THE EAR. 
 
 These rude endeavors in rough and unskilful hands 
 caused great pain^ which was erroneously supposed to 
 be due to the presence of the mud in the ear, and 
 therefore to demand further efforts for removal of the 
 offending substance. Hence they persevered with rude 
 forms of treatment until they succeeded in picking out 
 the drum and all the little bones of the ear, thus de- 
 stroying the hearing forever. A syringeful of warm 
 water thrown into this man's ear would have removed 
 the mud and restored him to comfort. In fact, had 
 the ear been let alone, it would have been far better in 
 every way, for the mud would have fallen from the ear, 
 in time, when dried. 
 
 In children who have placed beans and beads in 
 their ears, and have said nothing about it, for fear of 
 punishment, the foreign substance is often found years 
 afterwards in the ear, where it has lain without causing 
 any discomfort or doing any harm, beyond forming the 
 nucleus of a plug of wax. When the latter is syringed 
 out, the bead or the bean comes out with it. 
 
 Not long ago a child about ten years old was brought 
 to one of our hospitals, with the statement that she 
 had put a small ball of silver-paper, such as is wrapped 
 around tobacco, into her ear. It caused her no pain 
 nor any inconvenience, but the mother was alarmed at 
 the presence of the foreign substance in her child's ear ; 
 though she had only the child's voluntary statement 
 that the paper ball was in the ear. Xo one ever saw 
 this ball of paper in the patient's ear, and my belief 
 is that it never was there. The child had played with 
 it about her ear, had mislaid it, and then, going to her 
 mother, had informed her that she had put it into her 
 
DISEASES AND INJURIES OF EXTERNAL EAR. 45 
 
 ear. But the inexperienced resident who first saw the 
 patient was impressed with the statement of the mother, 
 thought he saw the silver-paper at the bottom of the 
 auditory canal (he probably saw the shining, silvery 
 drum), and proceeded to extract it. But deplorable 
 failure attended his efforts, as well as injury to the 
 child^s ear. He succeeded in badly tearing the skin 
 of the ear-canal and in punching a hole in the drum. 
 If the silver-paper was there, he pushed it into the 
 depths of the ear, out of sight, and set up great inflam- 
 mation and suffering in the little patient's ear. He 
 should have been sure first that a foreign body was in 
 the ear, and, secondly, he should have let it alone for a 
 more skilful surgeon to remove. 
 
 Of course foreign bodies in the ear should be re- 
 moved promptly, if it can be done properly, in order 
 to avoid possible irritation, or the accumulation of ear- 
 wax around them. But if their removal cannot be 
 done properly by a skilful hand, they had better lie in 
 the ear forever, than that the attempt at removal should 
 lead to such consequences as destruction of the drum, 
 with chances of deeper inflammation from such rude 
 surgery. The writer once removed a plug of wax 
 from the ear of an intelligent woman, fifty-eight years 
 old. Much to his and the patient's surprise, a solid 
 blue glass bead, of a strange pattern, rolled from the 
 ear into the basin during the syringing. The patient 
 stated that fifty years previous she had played with 
 beads like this one, and supposed she had placed one 
 in her ear and forgotten all about it. Gradually the 
 wax accumulated around the bead and led to deafness. 
 This is narrated here to show the comparative harm- 
 
46 DISEASES AND INJURIES OF THE EAR. 
 
 lessness of the presence of a bead or similar substance 
 in the ear^ when let alone. At worst such a substance 
 will form the nucleus of a wax plug, easily removable 
 by syringing. 
 
 In fact, the simplest, safest, and most agreeable way 
 to remove any foreign substance from the ear is by 
 syringing it out with warm water. This plan can be 
 pursued with both inanimate and living objects. 
 
 Insects in the Ear. — Great annoyance is felt both by 
 adults and by children from the entrance of insects into 
 the ears. A child, indeed, may be thrown speedily into 
 convulsions from such an accident. It happens that 
 flies, or ants, bed-bugs, fleas, small roaches, rose-flies, 
 and the like, get into the ear. Such an accident always 
 causes great discomfort and fright to any one, and a 
 child may be affected by it seriously, as stated above. 
 
 There is a branch of the pneumogastric nerve — the 
 nerve supplying the stomach, lungs,' and heart — going 
 to the ear. It is, therefore, very easy to excite cough- 
 ing, nausea, vomiting, and faintness from irritation of 
 this nerve-branch in the external auditory canal. Those 
 who sleep upon the floor in summer-time are liable to 
 experience this intensely-disagreeable annoyance by the 
 incursion of some of the beetle tribe so frequently 
 found at that season, running on the floors of our 
 dwellings. When the ear is thus entered by a small 
 insect, the first thing to be done is to pour into the ear 
 a little oil, say half a teaspoonful, and thus smother 
 the insect intruder. After it is killed it may be syringed 
 from the ear or lifted from it with delicate forceps. 
 
 Fly encapsuled in the Ear. — A boy, five years old, was 
 once brouo:ht to me for relief from deafness in one ear. 
 
DISEASES AND INJURIES OF EXTERNAL EAR. 47 
 
 Examination of the affected ear revealed the fact that 
 something black was lying in the auditory canal over 
 the drum. Upon syringing a little while, a small egg- 
 shaped capsule was removed from the ear. This small 
 object, about an eighth of an inch in diameter, proved 
 to be a house-fly wrapped up in dead skin (epithelium) 
 from the sides of the canal. His mother then recalled 
 the fact that when he was about a year and a half old, 
 while lying in his perambulator on the lawn, one warm 
 summer's day, he had suddenly begun to scream, and, 
 after giving further signs of suffering, had fallen into 
 a convulsion. In due time he passed from this state, 
 the cause of which had never been even surmised. It 
 seems probable, however, that in the discovery of the 
 dead fly in his ear we have an explanation of the cause 
 of the convulsion. The fly had been in the ear some 
 time, as shown by its envelope of dead skin, which 
 could only gradually form about it. 
 
 Syringing the Ear. — In syringing the ear, never use 
 cold water, as this is painful and productive of dizzi- 
 ness, and may induce inflammation of the drum and 
 the middle ear. The proper kind of syringe to use is 
 one made of hard rubber and known as a male syringe 
 No. 2. Before it is accepted from the draggist by the 
 purchaser, its piston should be known to move without 
 jerks. Unless the syringe works smoothly it will 
 throw water with such jerks as to alarm the patient, 
 and perhaps hurt him. The water can be held be- 
 neath the ear, in an ordinary old-fashioned finger-bowl, 
 which will also serve to catch the return current from 
 the ear. 
 
 The syringer should take hold of the auricle, at its 
 
48 DISEASES AND INJURIES OF THE EAR. 
 
 upper back edge, between two fingers, and by drawing 
 it gently upward and backward the auditory canal can 
 be straightened and the entrance of the water thus 
 facilitated. The nozzle of the syringe should then be 
 directed downward and forward, the stream of water 
 being passed inward upon the roof of the canal rather 
 than upon its floor. This manipulation, if properly 
 executed, will generally remove anything from the ear, 
 if it has not been wedged in by improper treatment. 
 
 There are many diseases of the auditory canal which 
 the professional reader may find explained in the larger 
 treatises on the ear. Here it is proposed to consider 
 only some of the simpler diseases affecting both the 
 auricle and the auditory canal, starting in the latter 
 and spreading to the former. Thus, erysipelas after 
 breaking out on the face and auricle may attack the 
 auditory canal, and reach even as far as the drum. Of 
 course every case of erysipelas of the face and ear is 
 a sign of constitutional disease and demands internal 
 treatment, prescribed by a physician ; but a word as to 
 the local treatment is demanded here. It will be found 
 that the best protection to the skin wdll be obtained 
 by covering it with a mucilage of slippery-elm bark, 
 quince-seed, or starch. If these cannot be procured, 
 protection from the air can be obtained by anointing 
 the auricle and the auditory canal, if it be involved, 
 with vaseline or albolene. It must also be remembered 
 that what is applied to the auricle and external audi- 
 tory canal may run down to the drum-membrane itself. 
 Hence, if iodine or nitrate of silver should be used 
 about the face they must not be allowed to get upon 
 the drum-membrane, as they would blister it. The 
 
DISEASES AND IXJUEIES OF EXTERNAL EAR. 49 
 
 same caution must be observed with any other blister- 
 ing drug. 
 
 Eczema of the Auditory Canal, — Sometimes acute 
 eczema attacks the ear, or even both external ears, at 
 the same time. In such a case some general constitu- 
 tional disturbance will be found to be the cause of the 
 local disease in the ear. Very often digestive, genito- 
 urinary, or uterine disease may be the underlying cause 
 of this eczema. Such must be inquired for and treated 
 whenever the physician is confronted wdth eczema of 
 the ear. The local irritation (burning and itching) 
 may be intense in these cases, and the first and greatest 
 endeavor must be made to relieve these symptoms. I 
 have found that in acute eczema of the ear-canal 
 " black wash'^ will usually give most relief to the in- 
 tense burning of the inflamed skin. 
 
 In chronic eczema, when the skin is thickened and 
 also inflamed, the suffering is not nearly so great, 
 though there is even in such cases much discomfort. 
 
 The thickening can be combated with citrine oint- 
 ment ; the crusts which form from the exudations from 
 the skin may be softened by vaseline or cosmoline, or 
 by sweet oil. A little plain w^ater would also do, ap- 
 plied on a soft rag, but under no circumstances must 
 any kind of soap be applied to the skin, in either acute 
 or chronic eczema of the auricle, or of any other part 
 of the body. 
 
 Boils, — Eczematous diseases in the ears are apt to 
 be followed by boils in the canal. These are generally 
 just within the mouth of the canal, and can usually 
 be seen as elevations in the skin, like boils anywhere 
 else. They usually come in a series of two or three, 
 c d 5 
 
50 DISEASES AND INJURIES OF THE EAR. 
 
 one succeeding another quite rapidly. They are in- 
 tensely painful, owing to the denseness of the skin 
 and the confined region in which they occur. The 
 skin lying within a bony boundary at this point of 
 the auditory canal, there is no room for swelling, and 
 hence the great suffering which ensues when a boil 
 occurs at this point. As the boil generally comes 
 where the auditory canal is attached to the skull, any 
 movement of the auricle, as with the hand or finger, 
 becomes very painful. 
 
 The pain and soreness can be relieved at the begin- 
 ning of the inflammation by applying to the boil a 
 piece of cotton soaked with a mixture of glycerin and 
 " black wash,^^ one part of the former to seven of the 
 latter. This will ripen the boil, i.e., bring it to a head, 
 and then it may be lanced if the pain continues. The 
 latter treatment can be done only by the hand of the 
 surgeon. 
 
 There are many domestic remedies frequently ad- 
 vised for the treatment of boils in the ear, such as a 
 roasted onion, fat pork, and various ^^ pain-killers.'^ 
 These must be most unequivocally condemned, as they 
 make the ear worse, by further inflaming the skin and 
 laying the foundation for other boils. Whenever they 
 are used, the pain is always most intense. They also 
 are forgotten and left in the ear after the pain subsides. 
 They then furnish an excellent soil for the growth of 
 a peculiar form of fungus, or mould, which has a 
 special tendency to grow in the ear if there is any de- 
 caying matter there for it to rest upon. The germs of 
 this parasitic plant are always floating in the air. It 
 will not grow in a normal ear, especially if the natural 
 
DISEASES AND INJURIES OF EXTERNAL EAR. 51 
 
 wax Is at the opening of the canal to protect it, as this 
 fungus will not flourish in the presence of ear-wax. 
 But if the ear-wax is removed, as it is usually in the 
 treatment which must be applied to a diseased ear, the 
 chances are then in favor of the entrance of this 
 fungus-germ into the ear and its settling on the decom- 
 posing fats, oils, or pieces of onion which have been put 
 into the ear to cure it. More will be said of this fungus, 
 when the disease it produces in the ear is considered. 
 
 Fungus in the Ear. — As has already been stated, the 
 fungus aspergillus may grow in an ear which has been 
 the seat of boils, and in which pieces of matter, or some 
 oils and fats used in treatment, have been allowed to 
 remain and decompose. Therefore after an attack of 
 boils in the ear the auditory canal should be syringed 
 and left in a clean state. 
 
 When the ear is attacked by the aforesaid fungus, 
 which always seeks the depths of the canal and grows 
 over the membrana tympani and the inner end of the 
 auditory canal near the drum, the first sensation is one 
 of fulness, and dulness of hearing. In a few hours 
 some burning, itching, and a little pain may be added 
 to the symptoms of fulness. In the course of twelve 
 hours, a watery discharge flows from the mouth of the 
 canal, and the ear feels still more stopped up. Some- 
 times the pain continues, especially if the fungus has 
 obtained a deep hold on the membrana tympani. The 
 only possible cure for this disease is the entire destruc- 
 tion of all the germs of the plant. If this is not 
 accomplished, the parasite may continue to flourish 
 indefinitely in the ear, producing fresh attacks of in- 
 flammation and pain. 
 
52 DISEASES AND INJURIES OF THE EAR. 
 
 Much can be done to relieve the patient from this 
 aural affection^ by gentle and persistent syringing with 
 tepid water. This acts mechanically in ridding the ear 
 of the germs or seeds of the parasite. If to this water 
 some alcohol is added, we have a means of destroying 
 the plant. But this application must be made not too 
 strong, or it will sting the broken skin in the ear and 
 cause the patient great suffering for a few moments, at 
 least. The alcohol should be only about one-eighth 
 of the fluid syringed into the diseased ear. The myce- 
 lial mass — that is, the roots, branches, and fruit-stalks 
 of the fungus- — ^raay also be removed from the ear and 
 the membrana tympani by gentle swabbing, if done 
 by a skilled hand. The most efficient and, in my 
 opinion, the infallible remedy is powdered salicylate 
 of chinoline, in combination with boric acid,^ blown 
 into the ear, after the latter is syringed. When an 
 ear affected with the growth of aspergillus in the 
 canal is examined with the funnel and ear-mirror, 
 the bottom of the canal looks as though filled with 
 a roll of wet newspaper. When this false membrane, 
 as it is called, is removed, the membrana tympani and 
 the walls of the canal near it appear red, rough, and 
 swollen. 
 
 SyphilitiG Eruptions, — The same papular eruption 
 which may invade the face and neck in secondary 
 syphilis may show itself on the auricle, in the auditory 
 canal, and on the membrana tympani. This can be 
 easily observed with the aid of the ear-funnel and 
 mirror if it makes its appearance in the parts of the 
 
 ^ One part of chinoline to sixteen parts of boric acid. 
 
DISEASES AND INJURIES OF EXTERNAL EAR. 53 
 
 ear just named. Usually such eruptions are best treated 
 by the constitutional remedies. 
 
 Shingles. — Shingles, or herpes zoster, sometimes at- 
 tacks the inner cup of the auricle and the entrance and 
 deeper parts of the auditory canal. This is a very pain- 
 ful disease. The patient, without any apparent reason, 
 begins to suffer from sharp and intense pain about the 
 auricle and the mouth of the auditory canal. The 
 pain is of the neuralgic type, and in the course of 
 twelve hours, at most, there will be observed, in the 
 line of the pain, a series of small pimples or blisters. 
 When these appear the pain ceases. These blisters 
 generally form a little matter, or pus, theu dry on the 
 top, and scale off. If the scab gets knocked off, or is 
 picked off by the patient, some stinging and pain will 
 ensue in the thus denuded spots. These painful points 
 should then be anointed with cold cream, simple cerate, 
 or albolene ointment. The true cause of this disease 
 in the ear is impoverished blood, and is an indication, 
 therefore, for building up the sufferer by internal treat- 
 ment. The symptoms about the ear generally fade 
 away in two or three days, unless the eruption is irri- 
 tated in some way by improper treatment or by picking 
 at it. Then boils or eczema may set in, and the ear 
 becomes very uncomfortable. 
 
 Neuralgia in the Ear-Canah — This is often a very 
 painful disease of the ear. It is usually due to a 
 diseased tooth or gum on the same side as the affected 
 ear. Sometimes neuralgia in the ear is an attendant 
 of neuralgia of the face and scalp, brought on by ex- 
 posure to cold wind. When due to diseased teeth, the 
 pain in the ear is often mistaken for that due to in- 
 
54 DISEASES AND INJURIES OF THE EAR. 
 
 flainmation in the ear, and is consequently improperly 
 treated by the sufferer or his friends. If there is pain 
 in the ear, without any attendant deafness, it will be 
 fair to conclude that the pain is neuralgic and not in- 
 flammatory. Very often the tooth which causes the 
 pain does not ache, nor is it even sensitive to the touch. 
 When toothache darts from a painful tooth to the ear, 
 the origin of the pain in the ear is plain enough ; but 
 often a toothache is really in the ear and nowhere else. 
 We do not find any discharge in these cases, nor does 
 the patient complain of deafness nor of noises in the ear. 
 
 Sometimes only a most careful dental examination, 
 even to the removal of a filling, is necessary before the 
 true cause of the earache is discovered. If this form 
 of dental irritation is reflected from the mouth to the 
 ear for any length of time, true secondary inflammation 
 and ulceration may be set up in the auditory canal 
 near the membrana tympani, and in children even the 
 latter important structure may become affected. 
 
 Unfortunately, very often this neuralgia in the ear 
 is mistaken for a sign of inflammation in the canal or 
 the drum itself, and improper remedies are pushed or 
 dropped into the organ. Among these are found all 
 kinds of oils, fats, spices, vegetables, etc., in reality 
 forms of poultices, which invariably further irritate 
 the ear, inflame it, and make matters much worse. 
 No local treatment of the ear will relieve neuralgia in 
 it, unless it be the application of dry heat to it. If 
 the pain is due to a diseased tooth, this must be cured 
 or extracted. Dry heat may be applied by means of 
 a salt bag, or by means of a flat four-ounce bottle filled 
 with hot water. 
 
DISEASES AND INJURIES OF EXTERNAL EAR. 55 
 
 Dental Plates and Fillings. — Not only do diseased 
 teeth often exert a bad effect on the external ear^ but 
 also dental plates and fillings are often the cause of 
 similar irritation.^ This is brought about in many- 
 ways. In general it may be said that many fillings 
 are put in on top of necrosed matter, or living but 
 diseased pulp. This induces great irritation from con- 
 fining the products of inflammation and retaining de- 
 composing matter. Dental plates act in a similar but 
 a more extensive way, from their larger size. They are 
 often put in over a number of rotten fangs, inflamed 
 gums, and collections of tartar, thus holding in the 
 mouth decomposing matter and inducing reflex irrita- 
 tion in the ear. Vulcanite, so often used for making 
 dental plates, is a non-conductor of heat, and, as Dr. 
 Sexton points out, "the effect of its contact with the 
 highly-sensitive tissue of the mouth is often to produce 
 hypersemia and inflammation.^^ This, again, has a 
 detrimental reflex effect on the ear. The author just 
 quoted gives 507 cases of disease of the external ear, 
 connected with or caused by irritation of diseased 
 mouths and teeth. Further effects of dental irrita- 
 tion in the ear will be considered under Diseases of 
 the Middle Ear. 
 
 Bleeding from the Ear, — Bleeding from the ear often 
 occurs in fracture of the base of the skull, and is to be 
 considered in these cases a very grave symptom. But 
 it occurs sometimes after injuries to the head, like falls 
 or blows, when there is no fracture of the base of the 
 
 1 See "The Ear and its Diseases," by Samuel Sexton, M.D.. 
 pp. 95-99, 1888, New York. 
 
56 DISEASES AXD INJURIES OF THE EAR. 
 
 cranium. Bleeding from the ear in these cases is due 
 to a laceration of the skin near the drum, and some- 
 times from a rupture of the drum-membrane. The 
 concussion of the air in the ear-canal, produced by the 
 fall or blow on the head, is so great as to bring about 
 a tearing of these delicate parts and a consequent hem- 
 orrhage. Sometimes blood runs from a wound in the 
 scalp or face, near the ear, into the ear-canal, and when 
 found there, or if it runs from the ear, a hemorrhage 
 from the ear is diaornosed and an alarmino; mistake is 
 thus made. Careful examination will reveal whether 
 the blood has come from the ear, by discovering the 
 ruptured spot from which it has flowed. In some low 
 fevers, hemorrhage from the ear may occur. It is a 
 symptom of great prostration. 
 
 Bone Tumors in the Canal of the Ear. — Hardness of 
 hearing, and even entire deafness, are caused by tumors 
 of bone which grow from the walls of the auditory 
 canal. Sometimes these can be seen by the unskilled 
 eye as greater or less elevations, covered with pinkish 
 skin, and projecting into the auditory passage at or 
 near its mouth. They cause no pain, and are often not 
 known to be in the ear, until some wax and dead skin 
 are caught behind the tumor and cause more or less 
 disturbance in the hearing. They are found in persons 
 affected with gout and rheumatism. They are also 
 more likely to grow in an ear which is the seat of a 
 chronic discharge, or iu the ear of a man who has been 
 a great swimmer and often under water. In the former 
 instance the constant discharge from the ear irritates 
 the tissues to such an extent that extraordinary out- 
 g^rowth of bone is excited, — a so-called exostosis, — and 
 
DISEASES AND INJURIES OF EXTERNAL EAR. 57 
 
 in time the bone tumor is developed. In the case 
 of the swimmer, the frequent entrance of water into 
 the ear acts as an irritant, and nature throws up 
 this bulwark against its further entrance into the ear. 
 This I take to be another indication that the en- 
 trance of cold w^ater into the .ear should be guarded 
 against. These tumors may enlarge slowly and en- 
 tirely close the auditory canal. Deafness, of course, 
 will be the result, curable, how^ever, by the removal 
 of the tumor. This can be done, and has been safely 
 and successfully accomplished in several ways, either 
 by drilling, chiselling, or cutting away the bony 
 growth. 
 
 If any one discovers such a bony growth in his ear, 
 he should be very careful not to wound the tender skin 
 over it ; because any slight swelling of this skin, ^vhich 
 ordinarily would not be noted, would quickly add to 
 the closure of the canal in which a bony growth had 
 already partially filled the cavity. 
 
 Sometimes cancer affects the ear, the result of either 
 picking the ear or getting severe blows upon it. This 
 is usually attended by severe pain and offensive dis- 
 charge, and would naturally lead the sufferer to a 
 physician, who would give proper directions for treat- 
 ment. The fact that cancer does occur in the ear as 
 the result of violence to it should lead all carefully to 
 avoid picking it with anything. In fact, the general 
 reader may learn from all of the foregoing pages, as 
 well as those to come, that the ear is composed of many 
 highly-organized and delicate structures liable to vari- 
 ous serious diseases, and that great care must be taken 
 of them. He must also learn that in many instances 
 
58 DISEASES AND INJURIES OF THE EAR, 
 
 he had better do nothing than to resort to his own 
 efforts or those of unskilful hands. 
 
 There is, however, a rational protection and care of 
 the ear — or a prevention of ear-disease — largely or 
 entirely within every one's control. 
 
 Hygiene and Avoidance of Disease, — Tlie bad results 
 of improper management of the toilet of the ear, such 
 as too much washing, picking, scratching, and swab- 
 bing, are constantly seen. If the reader will refer to 
 the anatomy of the auditory canal, he w^ill find that it 
 is lined with delicate skin, entirely dry and unobstructed. 
 At its mouth there will be found a thin film of wax 
 smeared around — not over — the opening. This wax 
 must be essential to the health and well-being of the 
 ear, or it would not be found there. It must not, there- 
 fore, be regarded as dirt. We see, then, that this au- 
 ditory canal must be entirely unobstructed in order to 
 permit sound to enter it and reach the drum. It needs, 
 therefore, a custodian at the entrance to keep out small 
 intruders, like insects, or the fungus aspergillus (p. 50). 
 This watchman is supplied in the ear-wax, because 
 insects are smothered in it, and aspergillus will not 
 grow on or near it. It may appear paradoxical that 
 nature should demand a free, open auditory canal and 
 yet be constantly forming a sticky substance in the 
 mouth of it. But this apparent paradox is overcome 
 by the fact that the skin of the auditory canal grows 
 outward, beginning at the drum-membrane, and carries 
 with it small quantities of superjiiious ear-wax, dust, etc. 
 In fact, a spot of any kind, like a minute fleck of 
 blood, may be watched as it starts on the surface of the 
 drum-membrane, and in the course of a week be seen 
 
DISEASES AND INJURIES OF EXTERNAL EAR. 59 
 
 far away from its starting-point, on the wall of the 
 canalj gradually nearing the mouth of the passage. 
 But the ear is not able thus to extrude large masses of 
 wax or anything else which has been packed or pushed 
 into the ear. Since we must regard ear-wax as a pro- 
 tector, and not as dirt, we should not try every day, 
 nor at all, to pick or scrape it out of the ear. Unfor- 
 tunately, this is done all the time, with injurious effects 
 to the ear. The necessary amount of wax is invisible 
 from without, and therefore need not give uneasiness 
 to those sensitive about their toilet. All superfluous 
 wax will in time roll from the ear-canal into the cup 
 of the auricle, and can be easily removed by a gentle 
 wipe of the finger-end. 
 
 It must, therefore, be very apparent that all the 
 undue efforts at a fancied toilet of the ear, in which so 
 many indulge, tend to interfere with the successful 
 operations of the natural processes of health in the ear. 
 
 Hardened Ear- Wax, — The formation of a hard plug 
 of ear-wax in the ear, and the attendant discomfort 
 and deafness, are entirely the result of misconceived 
 efforts at cleaning the canal. It is impossible for a 
 wax plug to form in the ear unless its escape is in some 
 way prevented by the efforts of the patient to get it 
 out. The use of any form of ear-pick, ear-spoon, ear- 
 swabs, like the rolled corner of a wash-cloth or a so- 
 called ^^ aurilave,^^ a piece of sponge fastened to a 
 handle, invariably packs in more wax than it gets 
 out, and always ends by forming a plug of wax, which 
 will cause great annoyance. 
 
 These plugs of hard wax are usually found in the 
 cleanest people, who are led by an erroneous idea of 
 
(50 DISEASES AND INJURIES OF THE EAR, 
 
 cleanliness to resort to various ways of getting wax 
 from their ears. Hence they drop into the auditory 
 canal sweet oil, glycerin, etc., and then go on swabbing 
 their ears, with the bad results already named. It is 
 hoped that those who read what has just been written 
 against such a false method of hygiene of the ear will 
 perceive the wisdom in letting their ears alone. 
 
 Not only may inconvenient deafness be induced by 
 this unwise meddling with the natural processes in the 
 ear, but positive inflammation and permanent injury to 
 the ear may be thus induced. Scraping away the ear- 
 wax from the opening of the auditory canal causes the 
 ear to itch. This leads to scratching the ear, and abra- 
 sion of the skin. The latter may pass into ulcerative 
 swelling and hardness of hearing. Or the juices of 
 the skin, which escape from the abraded spot, easily 
 undergo putrefaction, emit a disagreeable odor, and 
 supply a fitting soil for the growth of the fungus as- 
 pergillus (p. 50). When the ear is once invaded by 
 this parasite, much discomfort and injury may accrue 
 to the ear. The various greasy substances, both animal 
 and vegetable, so frequently put into the ear, in igno- 
 rance, will in time undergo decomposition, irritate the 
 ear, and lead to the growth of the aforesaid fungus. 
 
 Ilasses of Hard Skin in the Ear. — In some cases 
 masses of hardened skin, caused by the accumulation 
 of layers of the thin skin lining the canal, block the 
 passage and occasion great deafness. Very often in 
 these cases an ulceration of the skin beneath these hard 
 masses is found. The canal is also very sensitive, and 
 the ulcers demand most careful treatment. After the 
 plug of hard skin is removed, the hearing is generally 
 
DISEASES AND INJURIES OF EXTERNAL ^EAR. 61 
 
 entirely restored. The softening of these plugs can be 
 best accomplished by soaking them in a solution of the 
 following form : 
 
 R Sodse bicarb., gr. xx ; 
 
 Glyceringe, f^i; 
 
 Aquse, fjvii. M. 
 
 Warm fifteen drops of this and drop it into the ear 
 three times daily, holding it in the ear with a little 
 cotton. In the course of two or three days, syringe 
 the ear with warm water, and try to remove some of 
 the mass. In any case syringing alone is hardly enough 
 to remove the plug. It will be found necessary to 
 supplement syringing by piecemeal removal of the plug 
 of skin, by means of delicate forceps, introduced into 
 the ear, under perfect illumination, by a skilled hand. 
 
 Ear-wax forms most rapidly and in largest quanti- 
 ties in those having the most active perspiratory glands. 
 This can be observed in the laboring-man most fre- 
 quently; but it is also seen in private practice in 
 women and men who lead comparatively easy lives, 
 but who have dark skins and dark hair and active 
 perspiratory glands. With the greatest care to avoid 
 packing the wax into the ear, in washing, plugs of wax 
 may form every six months in the ears of such subjects, 
 causing deafness and discomfort and requiring syring- 
 ing in order to bring about relief. 
 
 Collections of wax will also form more readily in 
 the adult ear wath a small opening. This holds the 
 wax in the ear, and, as fresh wax forms behind the 
 first small accumulation, an obstructive mass is at last 
 found in the ear-canal. Deafness, buzzing in the ear, 
 and even dizziness, may now quickly ensue, and will 
 
 6 
 
62 DISEASES AND INJURIES OF THE EAR. 
 
 require treatment, either by syringe or forceps, at the 
 hands of a skilful person. The more tlie patient now 
 works over his ear, the worse he will feel. 
 
 Sweet oil, so frequently advised for the ear, is not 
 only useless, but, if it becomes rancid, is positively in- 
 jurious, like any other putrescent matter in the ear. 
 It has no solvent power over ear-wax, being of greasy 
 nature like the wax of the ear. If this has to be 
 softened, some form of alkali must be employed. 
 
 Glycerin has many advocates, in the treatment of 
 ear-diseases, among those who are ignorant of its true 
 qualities. It is by no means as bland as it looks, being 
 more like a mild caustic than a soothing substance. It 
 possesses great affinity for water, we are told by the 
 chemists, and therefore if put undiluted into the ear 
 it abstracts so much water from the skin of the organ 
 as to put it into a state of incipient inflammation and 
 cause stinging and burning. It undoubtedly has sol- 
 vent power on ear-wax and hardened skin in the ear, 
 but when used for this purpose it must be diluted at 
 least one-quarter. But pure water alone, if allowed to 
 remain in an ear filled with ear-wax, will soften the 
 latter and render it easy to be removed by syringing. 
 
 There is a popular but dangerous practice of treating 
 toothache by putting various remedies into the ear- 
 canal. It must be stated here most emphatically that 
 nothing must be inserted in the ear for this purpose. 
 This may immediately cause inflammation of the canal 
 and of the drum-membrane, and cause great suffering. 
 Sometimes the substance put in the ear to ease the pain 
 in a diseased tooth, causes no immediate injury to the 
 ear, and after the toothache ceases the substance put in 
 
DISEASES AND INJURIES OF EXTERNAL EAR. 63 
 
 the ear is forgotten and left there. Pepper-corns which 
 have been steeped in alcohol are thus used to cure 
 toothache, and are subsequently forgotten. In the 
 course of time^ if inflammation, or swelling only, occur 
 in the ear, with a cold, these pepper-corns are grasped 
 by the swollen skin and pushed into the inflamed sur- 
 face. This, of course, intensifies the inflammation and 
 causes great pain, from the entrance of the stimulating 
 juice of the pepper into the sensitive flesh. Then, 
 again, there is a mania on the part of many to drop 
 various fluids into the ear, for the imagined cure of 
 deafness. In fact, there is a laughable list of such 
 fanciful remedies, in which are found such things as 
 eagle's gall, rabbit's fat, human urine, human milk, 
 and neat's-foot oil. It need hardly be said, after what 
 has been set forth in these pages, that all such substances 
 are unable to cure deafness. They may, however, in- 
 jure the ear, by inflaming it and making the deafness 
 worse. Sometimes positively injurious substances are 
 recommended by one inexperienced person to another. 
 The writer knew of an instance where a servant was 
 advised by her mistress to pour boiling oil into her ear, 
 with the hope of curing her deafness. It would seem 
 that common sense should have prevented both the 
 advice and the following it, in this case ; but it did not. 
 The boiling oil was thus used, the ear was severely 
 scalded, the girl suffered intense pain, and destroyed 
 what little hearing she had in the misused ear. 
 
 Itching in the Ear. — At times itching in the auditory 
 canal is intense, and, of course, induces the sufferer to 
 scratch his ear. This is generally due to the fact that 
 the ear has been deprived of its wax by some of the 
 
64 DISEASES AND INJURIES OF THE EAR. 
 
 improper practices already alluded to. At other times 
 it is a symptom of catarrh of the ear, which brings 
 with it a deficient secretion of ear-wax. Generally a 
 little cold cream, vaseline, or cosmoline, smeared in the 
 ear by means of a camel's-hair paint-brush at the itching 
 spot, will relieve the discomfort. The finger should be 
 used very cautiously in scratching the ear, as the finger- 
 nail, never entirely free from poisonous matters, will 
 wound the skin and induce soreness and a discharge. 
 The ear should never be scratched with pins, hair-pins, 
 nor pencil-points and ends of pen-holders, as these 
 wound the skin and lead to ear-disease. There is also 
 danger of these implements being pushed suddenly 
 inward against or even through the drum-membrane. 
 This accident is brought about by the awkwardness of 
 the patient or by some one's running against his arm 
 while scratching his ear. 
 
 Itching of the ear may be caused by scales of dried 
 wax which have become adherent to the walls of the 
 auditory canal. In such cases syringing the ear with 
 warm water will remove the scales of wax and relieve 
 the itching caused by them. 
 
 Protection of the Ear in the Open Air. — The protec- 
 tion advised for the auricle, by means of ear-muffs, 
 scarfs, veils, etc., will also avail for the protection of 
 the auditory canal. When this part of the ear is af- 
 fected with neuralgia, when exposed to cold air or wind, 
 relief is often obtainable by wearing a little cotton-wool 
 in the mouth of the canal when in the open air, but 
 never in the house nor when the ear is discharging 
 profusely. Cotton should never be continuously worn 
 in the ear in the house, as it is too heating, keeps the 
 
DISEASES AND INJURIES OF EXTERNAL EAR, (55 
 
 superfluous wax from falling out (see p. 41)^ becomes 
 unclean, and is often forgotten. In the latter instance 
 it seems to work its way inward, and, getting packed 
 in with the ear-wax, leads to deafness. Greased cotton 
 may be worn in the ear to keep out water, when sw^im- 
 ming. It is not easy, however, to maintain it in this 
 position, unless a cap is worn to hold it in the ear. 
 There is no doubt of the risk of injury to the ear 
 which arises in swimming in cold water. A prolonged 
 swim, or numerous repetitions of such sport, are likely 
 to produce inflammation of the drum and consequent 
 pain and deafness. Hence the ear should be protected, 
 if possible, against the free incursion of cold water, 
 both in sw^imming and in cold-bathing. Cotton is 
 certainly the readiest means of securing some protec- 
 tion in such exposures. Furthermore, a cold bath or 
 a swim in cold water should not be indulged in too 
 long, if one cares for his ears. Boys and girls, who 
 can command it, should swim in a natatorium, where 
 the water is always kept at a safe temperature for 
 bathing, without risk of inflaming the ears or getting 
 chilled in other parts of the body. Bathing every day 
 in cold water or brook-water, as some boys and girls 
 do, especially in the country, is dangerous to health 
 and hearing, as fevers, catarrhs, and colds are thus easily 
 brought about. Surf-bathing has some dangers for the 
 ears, from the force of the breakers which may unex- 
 pectedly come against the side of the head and ears. 
 It is not uncommon for the drum of the ear to be thus 
 broken, and a painful and tedious ear-disease to be thus 
 set up. When such an accident does occur, the sufferer 
 should leave the surf at once, as it is the further en- 
 
66 DISEASES AND INJURIES OF THE EAR, 
 
 trance of cold water which does so much additional 
 harm to the ear. In fact, when the drum is thus acci- 
 dentally burst, nothing should be put into the ear. 
 The mouth of the canal should be protected with cot- 
 ton, in order to keep out even the air. 
 
 Sea-water, from its coldness and its stimulating saline 
 properties, is an irritant to the nose and the ear. Hence 
 there occur at every sea-side resort numerous cases of 
 ear-disease, from an earache of a few hours' duration 
 to long-continued inflammation of the ear and deafness. 
 This quality of sea-water and the consequent risks of 
 a too free use of it in the bath should lead to a more 
 cautious employment of what may be a means of health 
 if used judiciously. Unfortunately, there is a popular 
 idea that no one can take cold, either in or out of the 
 salt water, at the sea-shore. This has led to much dis- 
 comfort and disease in those who have acted upon such 
 a belief. A short bath or dip, once or twice a week, 
 if it is enjoyed, may be a good tonic in some cases, if 
 reaction is perfect, — ix., if no chilling occurs in the 
 water and if a glow keeps up after coming out of it. 
 But staying in the sea-bath until lips and ears, as well 
 as fingers and toes, are blue or purple, as some people 
 do, is most dangerous to health. Such imprudence 
 will certainly induce a catarrh of the bowels, the lungs, 
 or the head and ears. In fact, such complaints are 
 more numerous at the sea-side than anywhere else 
 among summer resorts. 
 
 Again, there is an erroneous idea, which has wrought 
 much injury, that no one can take cold after coming 
 out of a sea-bath; and hence people sit about in 
 draughts and ladies thus take an opportunity of drying 
 
DISEASES AND INJURIES OF EXTERNAL EAR. 67 
 
 their hair^ — which, by the way, should not be allowed 
 to get soaked with sea-water, as it is not easy to get it 
 dry again while at tlie sea-side, and hence their heads are 
 kept constantly damp, and catarrh is thus caused. Ear- 
 aches, deafness, and cold in the head are constantly in- 
 duced by their sitting in draughts of cool air after bath- 
 ing in the sea, and the foundations of deafness are thus 
 laid. In fact, it may be said that the sea-side is the place 
 where one easily takes cold, unless a rational, cautious hy- 
 giene is observed. The aurist constantly meets with ear- 
 disease which has begun by imprudence at the sea-shore. 
 
 The writer is among the number of those who hope 
 that the daily surf-bath of men, women, and children 
 will soon be obsolete. If the salt-water bath is de- 
 sired or advised, it should be taken in a private bath- 
 house, either in or near the hotel, w^here a proper 
 temperature can be assured for the comfort and the 
 health of the bather. Such a custom w^ould prevent 
 much disease of the ear, and promote the general health 
 of those who have to resort to salt-water bathing. It 
 would also prevent much that is grotesque in dress and 
 immodest in behavior, now the almost necessary attend- 
 ants of the public bath in the surf. 
 
 I cannot say too much in praise of sea-air as a tonic 
 in most diseases, and certainly for those who are affected 
 in their ears; but the latter class must refrain from 
 cold-water bathing in all forms. 
 
 DISEASES AND INJURIES OF THE MEMBRANA 
 TYMPANI. 
 
 The membrana tympani, or drum-membrane, on 
 account of its comparatively exposed position at the 
 
68 DISEASES AND INJURIES OF THE EAR. 
 
 bottom of the auditory canal is very liable to injury 
 and disease from without. As its inner surface is 
 covered with the same mucous membrane as lines the 
 drum-cavity, the membrana easily participates in the 
 inflammations of this space. The most common forms 
 of external violence which affect the membrana tym- 
 pani are concussions from blows on the ear, explosions, 
 the entrance of cold air and cold water, and the acciden- 
 tal insertion of slender, pointed implements. Some dis- 
 eases of the external auditory canal may spread to, and 
 inflame, the drum-membrane (see pp. 28-30). When 
 considering affections of the drum-cavity we shall also 
 mention the participation of the drum-membrane in 
 these diseases. At present let us consider some of 
 the results of external violence upon the drum-head. 
 The most common form of concussion applied to the 
 ear is by a " box on the ear." This may be strong 
 enough to rupture the drum and inflict serious con- 
 cussion upon the deeper structures of the ear, as will 
 be shown farther on. A slap or ^^box on the ear'^ 
 compresses the air in the auditory canal so forcibly at 
 times as to split the drum-membrane. Sometimes 
 these blows on the ear are given in rude play. I have 
 known such to rupture the drum and cause great suffer- 
 ing and injury. Usually these blows are given in pun- 
 ishment by the stronger man to the weaker child. It 
 is, therefore, a most senseless form of sport, and a cruel, 
 barbarous method of punishment. Explosions occur- 
 ring near the ear may cause a rupture of the drum. 
 This has happened from the explosion of gas-bags and 
 retorts in lectures, from the bursting of a large cannon, 
 and from being subjected to heavy cannonading while 
 
DISEASES AND INJURIES OF EXTERNAL EAR, 69 
 
 shut up in a casemate. A very common cause of a per- 
 foration of the drum, and even injury to the middle 
 ear beyond, is the accidental insertion of a slender, 
 pointed implement. This may be done by running a 
 twig in the ear while walking through dense under- 
 growth in the woods, or by having the end of an um- 
 brella-rib thrust into one's ear in a crowded place. The 
 drum-membrane may also be perforated while the ear is 
 being scratched with a hair-pin or an ear-pick, if the 
 elbow should happen to be knocked accidentally either by 
 the patient or by some one suddenly approaching him. 
 
 In many respects a perforation or rupture of the 
 drum-membrane, in the above-named way, is of no 
 great consequence, as it will generally heal in a healthy 
 membrane, if let alone. The great danger in these 
 cases is that the nerve may have been injured by con- 
 cussion, or that the instrument which has produced the 
 perforation may have broken or displaced the little 
 bones of hearing or injured in some way the middle 
 ear. There is also a danger that an ignorant person 
 may drop some kind of fluid substance, as a medica- 
 tion, into his ear, as soon as he finds out that the drum 
 is ruptured. In fact, such advice is sometimes given 
 by those who ought to know better. After a perfora- 
 tion of a healthy drum occurs in some of the aforesaid 
 ways, anything put into the external ear will flow 
 through the perforation into the drum-cavity and in- 
 flame it. Even the external air should be kept out of 
 an ear thus wounded, by placing cotton in the mouth 
 of the auditory canal. 
 
 In these cases of rupture of the drum-membrane 
 from concussion, or explosion, the force of the com- 
 
70 DISEASES AND INJURIES OF THE EAR. 
 
 pression of the air in the auditory canal comes suddenly 
 upon the membrana when it is not prepared for it. A 
 rupture of the membrane is also more likely to occur 
 in this delicate structure if weakened by previous dis- 
 ease, or if the Eustachian tube is closed by catarrh, 
 which prevents a recoil of the drum before the impact 
 of the explosive force. 
 
 Soldiers, spectators at military reviews, and sports- 
 men are liable to this accident. The former guard 
 against it by keeping their mouths open during heavy 
 cannonading. This insures an equal tension of air on 
 either side of the drum-membrane, as both the Eusta- 
 chian tube and the external auditory canal are sub- 
 jected simultaneously to the impact of the compressed 
 air. Wearing cotton in the ear at such a time is also 
 supposed to protect the membrana tympani from some 
 of the explosive force. 
 
 But many sudden explosions, like the explosion of 
 a gas-bag or retort in a lecture-room, or the premature 
 or unexpected discharge of a cannon or of musketry, 
 cannot be guarded against; and such occurrences are 
 likely to rupture the membrana tympani of some of 
 those very near the explosion. If, in addition to the 
 slight pain attending such a rupture of the drum, 
 there is also sudden dulness of hearing, the ear should 
 be at once examined by an expert. 
 
 The real damage in these cases is the possible con- 
 cussion and paralysis of the auditory nerve. If in a 
 case of ruptured drum from a '' box on the ear'^ the 
 sulBFerer sues the ao-g-ressor, the effect on the nerve must 
 be estimated, rather than the mere perforation in the 
 drum. If the nerve has not been injured, the perfora- 
 
DISEASES AND INJURIES OF EXTERNAL EAR. 71 
 
 tion in the drum will heal without any detriment to 
 hearing, in most cases, if it has not been improperly- 
 treated. In a trial of such cases, the previous state of 
 the hearing must be considered ; for it not unfrequently 
 happens that an ear which has received an injury from 
 a " box on the ear^^ was imperfect before the accidental 
 assault. In estimating damages in such a case, it must 
 also be found out whether anything was dropped into 
 the ear immediately after the blow, in order to heal the 
 ear. This improper treatment may be the real cause 
 of the subsequent inflammation of the ear, and deafness. 
 
 Effects of Alcohol and Tobacco, — The effects of drink- 
 ing alcoholic stimulants, and of using tobacco in various 
 ways, may be very injurious. These act by first stim- 
 ulating, congesting, and even inflaming the mucous 
 membrane of the throat, nose, and middle ear, and will 
 be more fully considered when diseases of the middle 
 ear claim our attention. It is after the middle ear is 
 diseased that these stimuli affect the drum-membrane. 
 It may be said here that the drum-membrane is some- 
 times directly irritated by blowing tobacco-smoke into 
 the ear for various reasons, mostly as treatment of some 
 form of ear-disease and pain, and also by wearing a 
 piece of tobacco in the ear, as some people — especially 
 the Russians — do, to protect, as they suppose, their ears 
 from cold and deafness. 
 
 Snuffing tobacco does most harm to the ears, and 
 ^^ smoking through the nose^^ comes next in order of 
 harmfulness, as they both congest the nose, Eustachian 
 tube, and middle ear, and then affect the drum-mem- 
 brane. 
 
72 DISEASES AND INJURIES OF THE EAR, 
 
 CHAPTER IL 
 
 DISEASES AND INJURIES OF THE MIDDLE EAR. 
 
 The middle ear comprises the Eustachian tube, the 
 drum-cavity, and the mastoid cells. The consideration 
 of its diseases and injuries becomes of the greatest im- 
 portance, as they are the most numerous and cause the 
 greatest number of cases of permanent deafness. Most 
 of the diseases of the middle ear are of a catarrhal 
 form, originating in the nose and the part of the head 
 behind the nose, the so-called naso-pharynx, or " nose- 
 throat,^^ where the nose and throat unite. 
 
 From this point the Eustachian tubes start and go 
 to the middle ear on each side. The nose, naso-pharynx, 
 Eustachian tube, the drum-cavity, and the mastoid cells 
 are lined with mucous membrane, and practically con- 
 stitute a continuous cavity lined with the same mucous 
 membrane. It is, therefore, very easy to see how a 
 disease beginning in or behind the nose, in the naso- 
 pharynx, readily affects the Eustachian tube and then 
 the middle ear. In fact, nasal and naso-pharyngeal 
 diseases are the true and frequent source of ear-disease, 
 passing up to the ear by the way of the Eustachian 
 tube. 
 
 Diseases of the throat or fauces unattended with 
 nasal disease are very rarely, if ever, causes of ear- 
 disease. A want of appreciation of this fact has led 
 to many errors in diagnosis and treatment of aural 
 disease, as much time and labor has been spent on 
 
DISEASES AND INJURIES OF MIDDLE EAR. 73 
 
 treatment of the throat which should have been ex- 
 pended on the nasal disease, in the case. But, strange 
 to say, in many cases of ear-disease the nose has not 
 been even examined, though the originating point of 
 the aural disease and deafness. Though all nose-disease 
 does not bring with it deafness, all catarrhal diseases of 
 the middle ear show signs of previous nose-disease, 
 which latter must receive treatment if the middle-ear 
 disease is to be successfully combated. While throat- 
 disease is rarely the cause of aural disease, nasal affec- 
 tions tend rapidly towards aural maladies in a large 
 proportion of cases. 
 
 Nasal diseases act disadvantageously upon the middle 
 ear in two ways : first, by direct extension of the catarrh 
 of the nose to the mucous membrane of the Eustachian 
 tube, and, secondly, by interfering with normal respira- 
 tion through the nose and thus depriving the Eustachian 
 tube and middle ear of its due ventilation. At every 
 act of swallowing the normal Eustachian tube opens, 
 and air enters the middle ear, or drum-cavity. This 
 entrance of air into the drum is attended with a gentle 
 clicking sound, audible to each of us when we swallow. 
 We are so used to this sound in our ears that we do 
 not notice it until our attention is called to it. 
 
 The bad effects of nasal inflammation are seen both 
 in acute and in chronic diseases of the middle ear. 
 
 ACUTE INFLAMMATION OF THE DKUM-CAYITY. 
 
 The most common cause of an acute inflammation 
 of the drum-cavity, the central and most important 
 part of the middle ear, is a cold in the head. Sore 
 throats come and go, without a cold in the head, and 
 
 D 7 
 
74 DISEASES AND INJURIES OF THE EAR. 
 
 hence without an inflammation in the drum-cavity. But 
 with a cold in the head nearly everybody experiences 
 at least a buzzing and a stuffy feeling in one or both 
 ears. It is but a slidino; scale from this first stao;e of 
 catarrhal ear-disease to a more severe and continual 
 ear-disease and deafness. This first sensation of fulness 
 and buzzing in the ear may disappear in a few days, 
 or it may gradually pass into a more marked sensation 
 of deafness, with an itching and burning sensation 
 passing up from the nose to the ear. This last sensa- 
 tion may glide into one of decided pain, at first dull 
 and intermittent, then much sharper and darting more 
 frequently into the ear or ears. It is not coQimon, 
 however, for both ears to be acutely inflamed at once. 
 This pain now grows worse, and is continuous. The 
 noises become of a pounding or crashing form, the head 
 grows dizzy, sleep is impossible, and if the patient is a 
 young child it may be thrown into a convulsion unless 
 speedily relieved. This is ^^ earache^^ in its worst form : 
 it is never a trifling matter in any form, AVith the 
 increase of pain, fever generally sets in. 
 
 Sometimes a quick relief comes to these cases by a 
 spontaneous rupture of the drum and an escape of mucus 
 or even pus. Again, a small blood-vessel in the drum 
 may burst from over-distention, and thus afford relief 
 to the intense suffering of the patient. Commonly, 
 however, the pain is not thus speedily terminated. It 
 goes on for several days, being worse at night, and it 
 then gradually subsides, either with or without the 
 occurrence of a spontaneous rupture of the membrana 
 tympani. If the latter event take place, the ear will 
 be found discharging a stringy muco-pus, and the hear- 
 
DISEASES AND INJURIES OF MIDDLE EAR. 75 
 
 ing will have partially returned. If such spontaneous 
 rupture have not occurred, the deafness will be found 
 to be profound, the patient's voice sounds strange to 
 him, there is a constant hissing in the ear, and often 
 the patient complains of dizziness, because the muco- 
 pus confined still in the drum-cavity is pressing on the 
 stapes and forcing it inward on the labyrinth-water, 
 which compresses the auditory nerve and affects the 
 brain. If both ears are thus affected at the same time, 
 the patient's condition is most deplorable. 
 
 Treatment. — If relief from pain takes place by the 
 spontaneous rupture of the drum, often the disease is 
 allowed to take its own course, ending sometimes in 
 healing, but more frequently in chronic disease. 
 
 A continuance of the pain, however, prompts the 
 patient or his friends to apply some form of domestic 
 treatment, and, this failing to relieve, medical advice 
 is sought. Most forms of domestic treatment in vogue 
 do more harm than good. In fact, they at least in- 
 crease the pain, if they do not prolong the disease. 
 They often do both. 
 
 Quinine. — When any one has taken a ^^ cold in the 
 head,'^ his ears are in danger of inflammation, though 
 the vast majority of patients do not know this. It be- 
 comes of the highest importance to the ears, now, to 
 adopt a proper treatment. The patient's mind must 
 be disabused of the very wide-spread popular notion 
 that ^^ a cold can be broken" by taking large doses of 
 quinine. Nothing, in fact, is more likely to bring on 
 a disease in the ear, which may otherwise escape, than 
 taking large doses of quinine, to check the cold, as 
 many say. They give to themselves and their friends 
 
76 DISEASES AND INJURIES OF THE EAR. 
 
 from ten to twenty grains at a time, usually with results 
 of further discomfort in the ears. Quinine tends to 
 congestion of all parts of the ear. The middle ear, 
 therefore, if congested by inflammation, will be further 
 congested and endangered by the above-named doses 
 of quinine. As a cold passes off, the debility which 
 it usually leaves behind it may be relieved by from 
 four to six grains daily, in divided doses of two grains 
 each. When we come to consider the diseases of the 
 internal ear, it will be shown that large doses of qui- 
 nine may permanently injure the auditory nerve. 
 
 High Feeding, — Another popular fallacy is that of 
 "feeding a cold,^' as it is called. The patient is told 
 to live well, eat much and highly-seasoned food, and 
 even to drink wines. Such a course is nearly as bad 
 for the cold in the head, and for the ears, as large 
 doses of quinine. The head is further congested, and 
 the ears either inflamed or made worse if already 
 affected. 
 
 When any one finds himself attacked by a "cold in 
 the head,^^ the first act should be to protect himself 
 from further chilling, and, if it be winter-time, to stay 
 in the same room, or the house equally heated through- 
 out, at a temperature of about 70^ F. Much below 
 this causes a feeling of chilliness, which is most de- 
 pressing and tends to further symptoms of cold. If 
 the thermometer rises much above 70° F. the head is 
 further congested, and the cold made worse. If the 
 ears have become inflamed, they generally feel worse 
 in a very warm room. In fact, sitting in a very warm 
 room in winter-time may induce a cold in the head. 
 It becomes evident, therefore, that whatever tends to 
 
DISEASES AXD INJURIES OF MIDDLE EAR. 77 
 
 congestion of tlie head, like quinine, alcoholic drinks, 
 very rich food, and overheated apartments, is likely to 
 congest and inflame the ears, and must therefore be 
 avoided, if we value our hearing. 
 
 Let us suppose that earache has come on after or 
 with a cold in the head. This indicates to the physi- 
 cian that an inflamed condition of the drum exists. 
 But the uneducated person, not knowing the true state 
 of things, and alarmed at the suffering of the patient, 
 proceeds to do something for the malady, usually 
 choosing something recommended by an entirely in- 
 competent adviser. The remedy most commonly em- 
 ployed by such domestic advisers is laudanum and 
 sweet oil. To say the least, the oil is heavy and loads 
 the already sensitive drum-membrane and increases the 
 pain from this cause. The laudanum often combined 
 with it, as it contains alcohol, being a tincture, is stim- 
 ulating to an inflamed or raw surface. Just as it or 
 alcohol in any form is to a fresh cut. Every one knows 
 how this smarts. Laudanum if put into a healthy ear 
 may penetrate the skin lining the ear-canal and drum- 
 membrane and inflame it. If such an effect can be 
 brought about in a healthy organ, it is easy to under- 
 stand that such treatment should not be applied to 
 an inflamed drum. But, unfortunately, this or some 
 other equally injurious form of home-treatment is 
 resorted to in every case of acute inflammation of the 
 ear, before the aurist is called in, and consequently he 
 finds, as it were, an artificial disease added to the spon- 
 taneous inflammation. The same condemnation may 
 be applied to the use of roasted onion, baume tran- 
 quille, pain-killers, etc. The onion macerates the ear 
 
78 DISEASES AND INJURIES OF THE EAR. 
 
 too much^ and leads to the growth of granulations or 
 proud flesh. Its juices, too, are stimulating, and in 
 the end painful. The various kinds of drops, as a rule, 
 increase the disease in the ear rather than diminish it 
 and the pain attending it. All forms of poultice, sucli 
 as bread-and-milk, flaxseed, boiled carrots, and the 
 like, placed over the ear, are decidedly injurious, in 
 the end, to the ear. This is due to their macerating 
 quality rather than to any irritant contained in them. 
 The softening brought about by their moisture over- 
 heats the ear-drum, causes the growth of granulations 
 or "proud flesh,^^ and may produce a permanent de- 
 formity in the ear, with consequent deafness of an 
 unchano^ino; form. It becomes manifest from what I 
 have said above that all forms of poultice, applied to 
 the ear in acute inflammation, are undesirable. 
 
 The only exception may be made in favor of plain 
 warm or hot water poured into the aching ear by the 
 teaspoonful. This may remain as long as its heat 
 seems to give relief. When it cools it must be allowed 
 to escape from the ear, and some more warm water put 
 in. This, however, is not as good as some form of dry 
 heat, or leeching. Let us first consider the application 
 of dry heat to the acutely-inflamed and aching ear. 
 
 Dry heat may be applied to the ear in various ways. 
 The simplest and often the quickest way to apply it is 
 by means of very hot water in a four- or six-ounce 
 bottle, a flat one being preferable. This should be 
 held against the cheek in front of the achino; ear, or 
 beneath it, or behind it, as seems most relieving to the 
 patient. Many patients prefer to place the bottle of 
 very hot water immediately against the cheek or ear. 
 
DISEASES AND INJURIES OF MIDDLE EAR. 79 
 
 Others prefer to place between the bottle and the cheek 
 a piece of flannel^ while the water is very hot. If ap- 
 plied at the right time, before any improper substance 
 has been put into the ear, I have never known this or 
 some other form of dry heat to fail to relieve. So 
 impressed have I been with this result in cases I have 
 seen at the outset of the inflammation, that I am forced 
 to conclude that most cases of earache which have re- 
 sulted in continued disease, especially in children, have 
 been made worse by the great variety of improper 
 remedies put into the ear at the outset, and thus 
 launched upon the career of chronic disease in which 
 I have at last found them. 
 
 A very similar method of applying dry heat is by 
 means of a hot-water bag. Its size may be an objec- 
 tion, unless it be quite small. Another good way of 
 applying dry heat to the inflamed ear is by means of 
 a salt-bag, a hot stone wrapped in flannel, or a heated 
 hop-pillow. The salt-bag may be made six or seven 
 inches in length, by three or four inches in width, and 
 one or two inches thick, and shaped like a bean or a 
 kidney. The notch on one side thus put in the bag 
 will enable it to be applied more easily close about and 
 around the ear. There has been lately made a rubber 
 bag somewhat in this shape, to wear under the chin, 
 over the larynx. Such a bag might also do for the 
 ear. 
 
 In some cases these simple remedies may not have 
 been applied at all, nor anything else, before the surgeon 
 is called in. It may then be too late for them to act 
 with good effect, and other measures for relief will be 
 demanded. If the inflammation and the pain have 
 
80 DISEASES AND INJURIES OF THE EAR. 
 
 grown intense^ and no rupture of the drum-membrane 
 has occurred nor seems imminent, abstraction of blood 
 from two or three spots near the auricle — not in it — 
 may be resorted to, by means of leeching. This can 
 be done either by applying two or three large Swedish 
 leeches, or by using the artificial leech. There are two 
 forms at least of the latter which may be used, — viz., 
 Heurteloup's, a French instrument, and that of Dr. 
 Gorham Bacon, of New York. The latter is simple 
 and efficient, and therefore decidedly preferable to the 
 larger and more expensive French instrument. The 
 object of leeching is to cut short inflammation and pre- 
 vent suppuration. If, however, the pain has lasted a 
 long time, or if it has lessened and the drum-membrane 
 is bulging outward, any form of abstraction of blood 
 is of no avail. The bulging of the drum indicates 
 that matter is behind it, and that the membrane must 
 be punctured or lanced. This of course can be done 
 only by the experienced hand. It gives relief to the 
 pain, permits the escape of matter through a small hole 
 at a well-selected spot, and thus prevents the pent-up 
 matter from bursting its way through the larger opening 
 which it is quite likely to make if left to itself. 
 
 After the perforation of the drum is made, either by 
 nature or by art, a discharge of mucus or muco-pus will 
 take place and continue for some days. This matter 
 should not be allowed to remain in the ears, as it under- 
 goes decomposition and irritates and makes the ear 
 worse. The odor of the decomposing matter in the 
 ear is very offensive, especially to the friends of the 
 patient. It is, therefore, a great mistake to put cotton 
 in a discharging ear, as it blocks the ear and prevents 
 
DISEASES AND INJURIES OF MIDDLE EAR. gl 
 
 escape of matter. The cotton soon gets soaked with 
 offensive discharge, and, acting like a poultice, macer- 
 ates and overheats the already diseased ear. In this 
 way ^^ proud flesh^^ or granulations are formed, the 
 perforation is made larger, polypi spring up, and the 
 hearing grows worse. If this condition of the ear is 
 allowed to continue, the hearing may be very soon 
 irreparably damaged. 
 
 As fast as matter forms in the ear, it should be per- 
 mitted to escape. If it is thin, it escapes much more 
 easily than if it is thick. In either case it may be 
 swabbed out with absorbent cotton twisted on a cotton- 
 holder and very gently inserted into the meatus, and 
 down the canal to the drum. Or, if this does not seem 
 to remove the matter from the ear, syringing with warm 
 water to which a little salt is added will usually suffice 
 to cleanse the ear of the discharge. The reader should 
 refer to the method of syringing the ear given on page 
 47. After the ear is thus cleansed, a little finely- 
 powdered boric acid may be blown into the ear, if it 
 has ceased to ache. This is best accomplished under 
 illumination of the diseased part by means of the fore- 
 head-mirror. It can, however, be done, by means of 
 a little powder-blower inserted into the mouth of the 
 canal, without illumination. But the operator is not 
 sure that the powder reaches the right spot unless the 
 ear is well lighted by the forehead- reflector. 
 
 It is not well to treat a running ear by the numerous 
 forms of drops so often resorted to and advised by one 
 patient to another. The only form of drops of much 
 value in these cases is a solution of carbolic acid, — of 
 not greater strength than from ten to fifteen grains to 
 / 
 
82 DISEASES AND INJURIES OF THE EAR. 
 
 the fliiidounce of water. No mistake could be made 
 in using this until a competent physician can be con- 
 sulted. But, aside from the few remedies named, 
 nothing else should be used by the patient or his friends 
 on unprofessional authority. But if the ear continues 
 sore or painful, it will be best to do nothing to it but 
 syringe it gently with warm water until medical advice 
 can be obtained. 
 
 Causes. — Acute inflammation of the middle ear is 
 likely to occur in scarlet fever, measles, diphtheria, 
 whooping-cough, and typhoid fever. Nurses and phy- 
 sicians must be on the watch for this complication, as 
 the patient may be too ill to draw attention to this 
 very important element in his disease. In typhoid 
 fever, as well as in scarlet fever, measles, and diph- 
 theria, the inflammation of the ear is due to the irri- 
 tation arising from the decomposition of inspissated 
 mucus and food in the back part of the throat and nose. 
 The fact that the nasal secretions do easily accumulate 
 in these diseases should be borne constantly in mind by 
 nurses, and they should see that the nostrils are kept 
 free. This can be done best by gently spraying the 
 nostrils, from in front, by a solution of carbonate of 
 soda, five grains to the fluidounce of water, or by 
 spraying these parts with some fluid albolene. The 
 latter is one of the latest products from petroleum, 
 being something like fluid cosmoline, but more fluid 
 than it, and entirely unlike it in being free from odor 
 and taste. 
 
 There are many other ways in which acute inflam- 
 raation of the middle ear, characterized mainly at first 
 by earache, can be produced. Some of these may be 
 
DISEASES AND INJURIES OF MIDDLE EAR. 83 
 
 called accidental, and others are due to a Avant of proper 
 care of the ears and nose. I have known an acute in- 
 flammation of the ear to be brought on by accidentally 
 allowing cologne-water to flow into the nostrils while 
 smelling it in a reclining posture. 
 
 Catarrh- Remedies, — In a similar way a so-called 
 catarrh-remedy has acted in a number of cases coming 
 under my notice. Almost all so-called fluid catarrh- 
 remedies, so loudly advertised everywhere, are ordered 
 to be snuffed into the nose. No matter what the 
 remedy, even if plain w^ater, it should never be snuffed 
 up the nose. This act of forcible inspiration is able 
 to draw the fluid into the Eustachian tube and middle 
 ear and inflame the latter. And in fact this accident 
 has often occurred. The dry snuffs (powders) are 
 nearly as bad, though they act more slowly, thickening 
 the mucous membrane lining the nose, naso-pharynx, 
 Eustachian tube, and middle ear, and finally inducing 
 hardness of hearing and deafness. It is seen, there- 
 fore, how necessary it is to advise strongly against 
 the use of anything recommended to be snuffed into 
 the nose. 
 
 Nasal Douche and Syringe. — The nasal douche comes 
 under this head, as also does the nasal syringe, simply 
 because the pressure of these instruments cannot be 
 accurately regulated. It requires but a little force to 
 send the fluid from the douche or nasal syringe up the 
 Eustachian tube into the middle ear. The writer has 
 known a simultaneous inflammation in both ears to be 
 produced by the unskilful use of a nasal douche. The 
 mistake in the employment of the nasal douche con- 
 sists in elevating the vessel containing the fluid — gen- 
 
84 DISEASES AND INJURIES OF THE EAR. 
 
 erally water with something dissolved in it — too high. 
 Instead of being above the head, the surface of the 
 fluid in the bottle should be on a level with the eyes of 
 the patient. The nasal syringe must never be used by 
 a patient upon himself or any one else. It must, 
 indeed, be used by a physician with the greatest cau- 
 tion. The writer never uses it in any way in the nose, 
 simply because of the danger of forcing water into the 
 ears. The nares are made to conduct air, and not 
 fluids of any kind. Hence flooding them with any 
 kind of fluid is risky for the integrity of the ears. 
 
 Swimming and Diving, — The earache and inflamma- 
 tion of the ear, which often follow a swim or a cold 
 plunge anywhere, are often largely, if not entirely, due 
 to the water which enters the nose at such times. A 
 sh'ght strangling or even coughing may then force 
 enough water into the Eustachian tube to enter the 
 middle ear and induce inflammation of that organ. 
 
 Doubtless, in swimming and diving, some water enters 
 the external ear, and may inflame the external canal 
 and outer surface of the membrana tympani. In many 
 cases the writer feels sure that the ear has been attacked 
 both in this way and by cold water forced up the Eu- 
 stachian tube into the middle ear. Many boys and 
 men swim and dive very frequently, with rarely if ever 
 any ear-disease in consequence. But enough cases of 
 inflammation of the ear do occur from this cause, to 
 render caution necessary in thus exposing so valuable 
 an organ of special sense to danger of great injury. 
 
 Washing the Hair. — Even washing the hair, in 
 women, and then exposure to open air or draughts 
 before it is entirely dry, has been the cause of inflam- 
 
DISEASES AND INJURIES OF MIDDLE EAR. 85 
 
 raation of the ear. When this part of the toilet is 
 performed, the hair must be most carefully dried by a 
 towel, in a warm room in winter-time, and in summer 
 in one free from strong draught. 
 
 Hair 'Cutting, — Men make a mistake in having their 
 hair cut short in winter-time and then exposing them- 
 selves to cold air, or even a storm^ in driving, riding, 
 or skating. This is often the cause of earache and in- 
 flammation of the middle ear, with not unfrequently 
 mastoid pain and congestion. If the hair must be cut 
 in very cold weather, whether it is only trimmed or cut 
 quite short, a comparatively mild^day should be chosen, 
 and an hour might be selected when immediate exposure 
 could be avoided by remaining in the house for a little 
 while after leaving the barber's hands. It is also an 
 additional safeguard against cold in the head and ears, 
 not to dampen the hair with anything after it has been 
 cut. There is no exception to be made in favor of 
 bay -rum, alcohol, etc., as these are worse than water, 
 because they evaporate more rapidly and thus reduce 
 the temperature of the scalp. The best course to 
 pursue after the hair is cut in winter-time is to decline 
 a '' shampoo" and insist upon a '' dry brushing,'^ unless 
 the tonsorial operation is performed in one^s own apart- 
 ments and one is going to remain in for an hour. All 
 these precautions at least indirectly tend to protect the 
 ear, and prevent pain and deafness. They are valua- 
 ble for those whose ears are good, and they are imper- 
 ative upon those whose ears are at all affected. But 
 we shall further consider the general hygiene of the 
 ear when alluding to chronic ear-diseases of a catarrhal 
 type. 
 
 8 
 
86 DISEASES AND INJURIES OF THE EAR. 
 
 CHRONIC PURULENT INFLAMMATION OF THE MIDDLE 
 
 EAR. 
 
 If an acate inflammation is followed by a discharge, 
 and the latter is improperly treated or neglected, a 
 chronic discharge will be set up. This is most apt to 
 be the sequel of the ear-discharge which occurs in 
 scarlet fever or measles, and always indicates a per- 
 foration of the drum. The quantity of the discharge 
 in such cases varies from a few drops to a teaspoonful 
 or two in twenty-four hours. Soaietimes it is hardly 
 copious enough to flow from the ear, while in other 
 cases it flows freely from the ear upon the cheek and 
 requires frequent wiping to prevent disfiguration and 
 irritation of the auricle and the skin near it. Espe- 
 cially is this the case in scrofulous children. There is 
 always a disagreeable odor connected with a chronic 
 discharge from the ear, due, of course, to the decom- 
 position of the matter. This may be a source of blood- 
 poison to the patient, or even to those with whom he 
 comes in close contact. Thus, a nurse or a doctor who 
 may be affected with a chronic discharge of matter from 
 the ear, the nose, or a decaying tooth may become a 
 source of contamination to their patients. There are 
 well-authenticated cases of childbed fever which have 
 been traced to contamination from the hands of the 
 physician, which had been previously soiled by wiping 
 or scratching his running ear. The same thing has oc- 
 curred from a decaying tooth and a purulent discharge 
 from the nose. These sources of pus render the breath 
 offensive and irritate a patient to further illness. If 
 the pus gets upon the hands of a nurse or a physician, 
 
DISEASES AND INJURIES OF MIDDLE EAR, §7 
 
 it may be conveyed to the patient^s body and thus 
 poison his blood. 
 
 But let us consider the effects of a chronic running 
 from the ear^ upon the patient. The hearing grows 
 steadily worse, and may be at last entirely destroyed. 
 The odor from the ear renders the patient a source of 
 discomfort to himself and to those with whom he 
 comes in contact. Granulations spring up and develop 
 into polypij in a chronic discharge in the ear. A long- 
 continued discharge is apt to lead to disease of the bone 
 of the middle and internal ear. Before this is brought 
 about, there may be many ^^ gatherings'^ in the ear, 
 with great pain. These are largely due to the decom- 
 position of the matter in the ear and further irritation 
 from this source. After the bone is finally attacked, 
 — eaten through, in fact, at some places, even as far as 
 the brain, — the patient is in danger of losing his life, 
 either from inflammation or from abscess in the brain. 
 If death is not brought about by brain-disease from 
 the inflamed ear, it is induced by pysemia, or blood- 
 poison, by absorption of the pus from the ear into the 
 blood. This often tends suddenly to inflammation and 
 abscess in the lung or liver, and rapid death. 
 
 Treatment of a Chronic Running from the Ear, — The 
 most the patient can do for himself in this disease is 
 to avoid bad self-treatment and to keep his ear clean. 
 The habit of wearing cotton in a running ear is both 
 injurious and unclean. It holds the matter in the ear, 
 favors its decomposition, increases the bad odor from 
 the ear, and causes proud flesh to grow and the inflam- 
 mation to extend deeper into the bone. One might as 
 well stop a running nose with cotton, as a running ear. 
 
88 DISEASES AND INJURIES OF THE EAR, 
 
 It overheats the ear, and thus induces all the bad 
 symptoms above named. If matter forms in the ear, 
 let it run out, by all means. The ear can be kept clean 
 by mopping it gently with absorbent cotton, or by 
 syringing it with tepid water once or twice a day, 
 according to necessity. More than this the patient 
 cannot do without expert advice. In most cases, if 
 anything is dropped into a running ear without the 
 advice of a physician, it will be a mistake and do harm. 
 The running is the only one of several symptoms of 
 ear-disease which the patient can see. What. the others 
 are, what importance should be attached to tliem, and 
 what should be the treatment demanded by them, only 
 the experienced eye can detect and direct. Polypi and 
 granulations must be removed, or the chronic discharge 
 will not cease. If the drum-membrane and little bones 
 of the ear are necrotic, i.e., half destroyed by disease, 
 their remnants may require surgical removal to insure 
 a cure of the disease, which otherwise may destroy life. 
 There is a popular idea, emanating from by-gone 
 days, when the nature of ear-disease was not as well 
 understood as now, that it is a bad thing to check a 
 running from the ears, for fear it will go somewhere 
 else and do harm. Nothing could be more erroneous 
 than this view. The truth is that, if a chronic dis- 
 charge of matter from the ear is permitted to go on 
 unchecked, the disease of which the discharge is a 
 symptom will go deeper, and may at last extend to the 
 brain or some other vital point. But the proper way 
 to check such a discharge is not by damming it up in 
 the ear with cotton, but to clean out the ear and apply 
 efficient medicines to the diseased mucous membrane, 
 
DISEASES AND INJURIES OF MIDDLE EAR. 89 
 
 iuside of the ear, from which the discharge comes. 
 Then when the discharge grows less under a proper 
 treatment^ it is an indication that the causative disease 
 is being overcome^ the ear made better^ and the general 
 ^velfare of the patient secured. 
 
 There are many ways to accomplish this most desira- 
 ble end, both by fluid applications and by insufl3ations 
 of powders into the ears. If the perforation in the 
 drum-membrane is large, I incline to the latter form 
 of treatment; but if it is small, the former may be 
 used with advantage. 
 
 Polypi and their Treatment. — After a discharge from 
 the ear has become fully established, even in the course 
 of a few weeks, a polypus may grow in the organ thus 
 affected. Usually it requires a long duration of a puru- 
 lent discharge from the ear to cause a polypus to form 
 in it. After such a growth has developed in the ear, 
 it will not disappear until removed by surgical art. 
 The discharge by its irritating and moistening effects 
 has brought about the polypus, and the latter acts as a 
 stimulant to further discharge from the ear, so that 
 finally these two causes, reacting upon each other, seem 
 to combine to continue and to increase the aural disease. 
 The matter formed now in the ear cannot so easily 
 escape, on account of the partial obstruction from the 
 polyp. This lessening of the way of escape of the 
 pus favors its decomposition in the ear, the odor is thus 
 increased, and a constant irritation is thus set up in the 
 ear. A discharge from the ear will never stop as long 
 as a polyp is in it. 
 
 Treatment — The first step in the treatment, therefore, 
 is to extract the polyp and prevent its return. Re- 
 
 8^ 
 
90 DISEASES AND INJURIES OF THE EAR. 
 
 moval of a polyp from the ear may be accomplished 
 either by grasping it with delicate^ slender forceps (of 
 course under good illumination from light reflected into 
 it by the forehead-mirror) or by the use of a so-called 
 polypus-snare. The latter consists of a loop of delicate 
 wire, the ends of which run through a slender steel 
 barrel and are then fastened to a sliding holder on the 
 shaft. This holder may be drawn towards the operator, 
 and the loop of wire at the distal end of the steel 
 barrel thus constricted. When the loop has been 
 placed around a polypus, the above-named manipula- 
 tion will sever it from its stem, and it can then be 
 easily removed from the ear with the instrument. 
 
 This, however, is but the first step in the radical cure 
 of a polypus in the ear. The root, or attachment of 
 the polyp, must be touched with some caustic, in order 
 to prevent regrowth. The bleeding from the seat of 
 the attachment of the polypus is slight. Most polypi 
 are attached to their pedicle very much as a cherry is 
 to its stem, and a clean removal can in such a case be 
 made very easily. AVhen the polyp is broad and at- 
 tached to a pedicle of the same width, it is harder to 
 remove it entirely at one constriction of the snare. In 
 any event the section of the pedicle in such a case will 
 be broad, and will require perhaps further snaring, and 
 certainly more treatment with caustics, to insure its 
 destruction. 
 
 "When a polypus is finally entirely removed and its 
 root destroyed, the discharge will cease, as a rule, very 
 soon. There may be a concealed polypus which keeps 
 up the discharge after the visible polyp is removed. 
 If after the removal of a polyp the running from the 
 
DISEASES AND INJURIES OF MIDDLE EAR. 91 
 
 ear still continues, the presence of a concealed polypus 
 should be suspected. This will generally be found 
 behind the rim of the drum, at its upper part. It will 
 be more likely to come into view after the first polyp 
 is removed, as the latter often seems to push it out of 
 sight. Close examination of the ear, after syringing 
 it, will generally reveal at least the lower edge of a 
 concealed polypus, if present, projecting from behind 
 the plane of the membrane. Such a polypus is usu- 
 ally smaller than the outer one, and can be re- 
 moved, as a rule, only by a delicate hook on a 
 slender shank. A snare could hardly be made to 
 serve so far in the ear as the attachment of a con- 
 cealed polyp, as it is behind the plane of the membrana 
 tympani. 
 
 No form of local application will cause a polypus to 
 shrink and drop from its stem. It must be removed 
 as above stated. 
 
 Mastoid Disease, — Chronic purulent disease of the 
 drum-cavity, either with or without producing polypi 
 in the ear, may extend its ravages inward and back- 
 ward to the mastoid cells. These cells are in the 
 rounded bone behind the auricle, easily seen or felt in 
 any one. After chronic purulent disease in the mid- 
 dle ear has become fully established, the patient, upon 
 taking cold, or after a bath in cold water in summer- 
 time, may feel an earache, which gradually passes back- 
 ward and inward towards the mastoid cells in the afore- 
 said region behind the auricle. The bone behind the 
 ear grows tender to the touch, it may also become boggy 
 and swollen, and the pain within the bone may be in- 
 tense. Headache and fever are usually added to the 
 
92 DISEASES AND INJURIES OF THE EAR. 
 
 other symptoms^ and sometimes the patient grows de- 
 lirious. The discharge from the ear may now suddenly 
 grow much less, or cease entirely, to be re-established 
 as the acute symptoms subside. 
 
 Mastoid symptoms of pain, tenderness, and swelling 
 sometimes attend inflammation in i\\Q external auditory 
 canal. If there has not been any long-continued run- 
 ning from the ear, these symptoms need occasion no 
 alarm. They will usually yield to poulticing behind 
 the ear. 
 
 If, however, other symptoms occur in an ear previ- 
 ously the seat of long-continued discharge of pus, they 
 may indicate serious inflammation of the bone, near the 
 brain. The middle ear should be examined and the 
 auditory canal made free. If polypi or granulations, 
 i.6., proud flesh, are present, they should be removed, 
 so that pus may escape from the ear. Warm fomen- 
 tations, poultices, and leeching over the mastoid, should 
 be tried. Such a case demands careful watching and 
 treatment, as pus may form within the mastoid cavity, 
 and, if not given a way of escape, may force its way 
 through the inner wall of the mastoid cavity into the 
 lateral sinus, an important blood-vessel of the brain. 
 When it reaches this point the condition of the patient 
 is hopeless. 
 
 When pus forms within the mastoid cavity and seems 
 not to have free escape through the middle ear, the 
 outer mastoid wall, behind the auricle, must be per- 
 forated. 
 
 Sometimes the chronic disease in the drum commu- 
 nicates itself to the bone on the inner and upper wall 
 of the drum-cavity. It thence extends itself to the 
 
DISEASES AND INJURIES OF MIDDLE EAR. 93 
 
 membranes of the brain lying just beyond, and the 
 result is a fatal one. In such cases the mistake has 
 been made in a too precipitate determination to perfo- 
 rate tlie mastoid. Such an operation would now be 
 futile as a remedy for a meningitis already established, 
 unless it is proposed to make such an opening in the 
 mastoid the starting-point of an operation to enter the 
 skull-cavity and drain an abscess in the brain which is 
 supposed to be not far from this point of entrance. 
 All of these procedures demand the highest surgical 
 knowledge and skill. 
 
 Loose Pieces of Dead Bone, — A mastoid inflamma- 
 tion, especially if it has spent itself on the outer table 
 of the mastoid cavity, often ends in loosening this outer 
 table or a scale of bone near it. These cases are also 
 attended with spontaneous openings in the bone near 
 or in the mastoid wall, which continue to discharge 
 matter for some time. If a probe is put into these 
 openings, dead bone will be felt. Gradually this dead 
 bone will be found to be loose and making its way out- 
 ward towards the opening. Such pieces of loose bone 
 should be removed as soon as possible, as, if allowed 
 to stay in beneath the skin, they tend to poison the 
 blood, by forming a centre of decay and infection. 
 Slitting open the skin and seizing the edge of the 
 loose bone with forceps, and a removal of it, will 
 generally terminate the discharge which has been going 
 on from both the ear and the spontaneous opening be- 
 hind it. It will be observed that now the general 
 health of the patient will improve, because a source of 
 infection of his blood has been removed. 
 
 Nose and TIiroaL — It has been stated already that 
 
94 DISEASES AND INJURIES OF THE EAR. 
 
 most acute inflammations and runnings from the ear are 
 due to inflammation in the nose, or a cold in the head. 
 Often the nasal disease passes away with the acute aural 
 inflammation. If a chronic discharge from the ear con- 
 tinues, it may be quite positively assumed that the nose 
 too remains diseased from previous attacks of cold and 
 other irritants. So far as treatment of the nose is con- 
 cerned, the patient can himself do little towards making 
 a nasal disease better by direct treatment. But he can 
 do much in the way of hygiene to make his condition 
 better and ward off future attacks of cold in the head 
 and permanent deafness. The reader is reminded of 
 what has been said already (pp. 65-67) about swimming 
 and diving in cold water, the use of the nasal douche 
 and nasal syringe, and also concerning taking large 
 doses of quinine and the common but erroneous use 
 of so-called catarrh-remedies. The same statements 
 must be repeated here, as important advice to those 
 afflicted with chronic discharges from the ear. If 
 chronic catarrh of the nose and throat are not relieved, 
 the chronic ear-discharge cannot be checked. Every 
 precaution must be taken against using improper rem- 
 edies, and also against taking cold. But more will be 
 said about the hygiene of the throat and nose when 
 considering chronic catarrh of the middle ear and the 
 deafness attending it. 
 
 CHRONIC CATARRH OF THE MIDDLE EAR. 
 
 We now come to that disease of the middle ear 
 which produces the most deafness, — viz., chronic ca- 
 tarrh of the middle ear. This disease has received 
 many names, among which may be mentioned '^ chronic 
 
DISEASES AND INJURIES OF MIDDLE EAR. 95 
 
 thickenino; and harclenino: of the druQi,'^ ^' chronic 
 stiffening of the joints of the little bones of the ear/^ 
 "sclerosis (hardening) of the middle ear/^ '^nervous 
 deafness/' and many others^ all based on some of the 
 prominent symptoms of the disease. The one most 
 commonly used is at the heading of this paragraph, 
 and is probably the best, because it most nearly ex- 
 presses the true nature and origin of the disease in the 
 majority of cases. After a very bad cold in the head, 
 which has been attended with inflammation in the nose, 
 Eustachian tube, and drum-cavity, and which has been 
 characterized by deafness and sometimes by pain, as the 
 latter ceases, the hearing may only partially return to 
 its previous condition. This is due to the fact that the 
 swelling in the mucous membrane of the nose. Eusta- 
 chian tube, and drum-cavity has been so great that they 
 do not regain their previous normal state, and that 
 the ear in consequence is in the first stage of chronic 
 catarrh and deafness. Air which should enter the 
 Eustachian tube and middle ear at each act of swal- 
 lowing, and which should pass through the nose at 
 each respiration, in order to be near the mouth of the 
 tube, to enter the ear, is kept out of these cavities by 
 the impediment due to the swollen mucous membrane 
 which forms their lining. This condition of the mu- 
 cous membrane of the nose and middle ear is rarely 
 the result of one cold. It will usually be found that 
 the patient has been long liable to take heavy colds in 
 the head and sometimes has been equally liable to sore 
 throat ; though usually it is chiefly the nose in its back 
 part which has been affected. Then the ears have felt 
 stuffed with each cold in the head, and there have been 
 
96 DISEASES AND INJURIES OF THE EAR, 
 
 some hissing or ringing sounds in them. For a long 
 time these ear-symptoms pass ofiF after the severity of 
 the head-cold has vanished. Or a little dulness of 
 hearing may be noticed to remain after a cold. Then, 
 after another cold the hearing is a little duller^ the ear 
 not returning again to its once sharp hearing. This 
 may not be considered of much importance at first; 
 but as inconvenience is gradually felt from the slowly- 
 increasing deafness, and as the noises in the ears and 
 head increase, the patient grows anxious or alarmed 
 about his failing hearing, and seeks aid. Sometimes 
 the roaring in the ears, and the stufiPed or full feeling in 
 them, are so great as to cause dizziness and even stag- 
 gering. In such instances the patient has the addi- 
 tional suflPering from what is called aural vertigo 
 (M^ni^re's disease). As the nose is often very much 
 stopped by its swollen mucous membrane, the enun- 
 ciation of the patient becomes indistinct, or nasal as 
 it is called. In some instances, especially when this 
 disease begins, the patient's voice sounds peculiar to 
 him, and as though he were speaking in a closet or 
 a box. In the speech of others the patient loses the 
 consonant-sounds first, but hears the vowel-sounds. 
 Thus, for ^^ pin^^ he thinks '' bin^^ or " tin'^ is said. 
 All ages may be afflicted with this form of ear-disease. 
 Chronic catarrh of the middle ear is without doubt the 
 cause of a child's being deaf and dumb. In it the 
 disease may have begun shortly after its birth, with a 
 severe cold, which has been forgotten. As it is too 
 young to even know its own deafness, and as its par- 
 ents do not require to talk to it in infancy, with the 
 expectation of communication with it, they are unaware 
 
DISEASES AND INJURIES OF MIDDLE EAR. 97 
 
 of the beginning of deafness. Thus the profound deaf- 
 ness is founded, because, being unrecognized at its 
 beginning, it receives no treatment. 
 
 Colds in the head are the chief cause of chronic 
 catarrh in the ears. But it often is due to scarlet fever, 
 measles, and skin-diseases in childhood, and to typhoid 
 fever and childbed in adult life. In children one of 
 the first symptoms of nose- and ear-disease, with hard- 
 ness of hearing, is " mouth-breathing :'^ the child 
 breathes through its mouth instead of through its nose. 
 This causes a dryness and finally disease in the throat. 
 The disease of the nostrils causes them to become 
 further impeded inside, from a want of the necessary 
 stimulus of the respired air. Outside, on its sides, or 
 '' wings,^^ the nose falls in and looks pinched. The 
 back part of the nose is deprived of air, and hence the 
 middle ear fails to get its supply of air and its function 
 is impaired. 
 
 When this defective aeration of the drum-cavity 
 once sets in, the patient is advancing in his deafness; 
 for if aeration or ventilation of the tympanic cavity 
 stops for a short time only, the ear is put in the first 
 stage of deafness. Such a condition must be overcome 
 as soon as observed. In children we must be on the 
 lookout for stopped nose and relieve it, or have it 
 treated, at once. Adults . should be careful not to 
 breathe through the mouth, especially in the open air; 
 and if this seems difficult, they should have the nose 
 put in a condition to permit easy respiration and check 
 mouth-breathing. Mouth-breathing is not only preju- 
 dicial to good hearing, but it tends to bring on throat- 
 and lung-disease, because the respired air is taken 
 
 s ^ 9 
 
98 DISEASES AND INJURIES OF THE EAR, 
 
 directly into the throat and lungs, without being first 
 warmed and sifted of dust in the nose. 
 
 Effects of the Use of Tobacco on the Middle Ear. — 
 Men who snuff*, chew, or smoke tobacco are liable to 
 chronic catarrh of the throat and nose, and hence to 
 chronic catarrh of the middle ear. Especially is 
 chronic catarrh likely to be produced in one who 
 smokes through his nose. It matters not whether it 
 is cigar, pipe, or cigarette smoke : one kind of smoke 
 is no worse than any other : it is only the method 
 of inhaling it. Cigarettes are not harmful as such. 
 They are convenient, and hence smoked excessively, 
 and their smoke is often chosen to be blown through 
 the nose. But the bad effects would be the same with 
 an equal quantity of any other kind of tobacco-smoke 
 used in the same way. 
 
 Snuff is especially bad for the nose and ears, as it is 
 applied directly to the nose, irritating it and, indirectly, 
 the ears. 
 
 Chewing tobacco is worse for the throat than it is 
 for the ears. Its bad effects arise from the fact that a 
 chewer of tobacco generally keeps a piece constantly 
 in his mouth, and thus allows the throat to be bathed 
 with tobacco-juice almost all the time. 
 
 Effects of Alcoholic Drinks on the Ear. — Those who 
 drink alcoholic drinks to any extent keep up a catarrh 
 in the nose and throat, and hence in their ears. There- 
 fore we find chronic catarrh of the middle ear very often 
 in those given to drinking spirits or high wines. This 
 habit tends to excite a congestion of the head in general, 
 and the nose and ears share quickly in its evil effects. 
 In advanced catarrh of the middle ear the deafness is 
 
DISEASES AND INJURIES OF MIDDLE EAR. 99 
 
 always worse after indulging in free drinking. In 
 some cases very little potation is required to make the 
 deafness much worse. It also congests the nerve of 
 hearing in the internal ear. 
 
 SYMPTOMS OF CHRONIC CATARRH OF THE MIDDLE 
 
 EAR. 
 
 Chronic catarrh of the middle ear comes on in- 
 sidiously. As one ear generally fails some time before 
 the other, the ear first affected may become very deaf 
 before the patient is fully aware of his loss. This is 
 often discovered accidentally, as when lying on the 
 good ear, in bed, he suddenly finds that he cannot hear 
 a clock tick or the rain falling. Sometimes deafness 
 in one ear is not discovered until the other ear begins 
 to fail in hearing. If both are affected at the same 
 time, the patient feels very quickly his deficiency. 
 
 If among the earliest symptoms, as is very often the 
 case, there are noises in the ear, they constitute valuable 
 warnings of the approach of the disease. Sometimes, 
 liowever, the hearing fails before the noises begin in 
 the ear. These resemble the ringing of distant bells, 
 the escape of steam, or the roaring of a sea-shell held 
 to the ear. At first such noises are heard only at 
 night, or early in the morning, or when the patient is 
 in a quiet place. Gradually they become louder and 
 continuous and give great discomfort and annoyance. 
 In many cases there is an increased sensitiveness to 
 sound in the early stages of chronic catarrh of the 
 middle ear. Loud noises, like those in the street or in 
 a machine-room, hurt the ear in such a state. It 
 would appear that in some cases the patients get used 
 
100 DISEASES AND INJURIES OF THE EAR, 
 
 to these noises in the ears and head. But they vary in 
 intensity in the same individual^ and in different cases 
 of aural catarrh. Their intensity is often dependent 
 upon conditions of the digestive apparatus or of the 
 genito-urinary organs. 
 
 Pain, of a dull kind, is felt from time to time in 
 chronic middle-ear catarrh. This is neuralgic and due 
 to the pressure of the swollen mucous membrane on 
 the nerves of the middle ear. At the same time there 
 is generally a dull pain over the eyes or in the root of 
 the nose. Instead of this pain in the ear there may be 
 a sense of fulness in the ear, as though it were stuffed 
 with cotton. These symptoms are always worse in 
 winter-time or whenever the patient has cold in the 
 head. They are also aggravated by stimulating food 
 and wine-drinking, by dyspepsia, and by constipation 
 of the bowel. If there is an active secretion in the 
 posterior part of the nose and in the Eustachian tube, 
 much annoyance is caused by the crackling sounds 
 made by bubbles in this fluid, and the patient^s voice 
 sounds very strangely in his own ear or ears, from the 
 swollen condition of the Eustacliian tube and middle 
 ears. 
 
 Vertigo is often felt in the later stages of this disease, 
 especially in the nervous and those suffering from 
 nervous prostration. Such subjects are easily rendered 
 vertiginous by any cause, but become especially liable 
 to vertigo and dizziness if their ears are affected by 
 catarrh. Attacks of ear-vertigo, as it now becomes, 
 are usually preceded by a fresh attack of tinnitus or 
 by an increase of the buzzing or ringing already in the 
 ear. The deafness, too, usually gets worse just before 
 
DISEASES AND INJURIES OF MIDDLE EAR. IQl 
 
 or during the attack of vertigo. Sometimes only a 
 dizziness is felt, with a little unsteadiness in the gait. 
 In other instances the vertigo is intense, nausea comes 
 on, and the patient reels and clings for support to any- 
 near object. At times the vertigo is so great as to cause 
 the patient to fall down, and sometimes the nausea be- 
 comes so oppressive as to induce fainting. 
 
 In an ear affected with chronic catarrh, the membrana 
 tympani is both stiffened and drawn inward, and thus 
 held, by the retraction of the tensor tympani muscle. 
 This draws all the ossicles inward and forces the foot- 
 plate of the stirrup-bone in upon the fluid in the laby- 
 rinth. Pressure is thus exerted upon the terminal fila- 
 ments of the auditory nerve, in the labyrinth. As the 
 auditory nerve contains motor as well as sensory fibres, 
 the irritation conveyed by this pressure upon the audi- 
 tory nerve, to the brain, causes dizziness and vertigo. 
 
 Hearing better in a Noise, — In the advanced stages 
 of catarrh of the middle ear the patient usually hears 
 better in a noise. This is not a favorable sign, as it 
 indicates that the chronic catarrh has profoundly af- 
 fected the drum-membrane and the little bones in the 
 middle ear and led to their stiffening. Ordinary 
 sounds, like those of the voice, cannot overcome this 
 stiffening and make the drum and bonelets vibrate, 
 but powerful noises can temporarily overcome this 
 stiffness and cause vibrations in the sound-conductors. 
 When such take place, the sounds of the voice and 
 many weaker sounds enter the ear, as it were, with the 
 powerful sounds which have opened the way, by making 
 the conductors move to and fro, or vibrate, as it is 
 properly termed. 
 
 9^ 
 
102 DISEASES AND INJURIES OF THE EAR, 
 
 Heredity, — There is often a marked hereditary ten- 
 dency to chronic catarrh of the middle ear in some 
 families. This is due to the presence in the middle 
 ear of bands or strings of a fibrous nature which inter- 
 twine between the bones and the inner wall of the 
 drum-cavity and prohibit free movements in the con- 
 ductors of sound. The odor in chronic catarrh of the 
 middle ear and of the nose is not usually of the offen- 
 sive kind. 
 
 In chronic catarrh of the middle ear characteristic 
 changes appear in the external auditory canal. These 
 consist chiefly in a diminished or even a suspended 
 secretion of ear-wax. The wax may be very brittle 
 and small in quantity. In many cases there is no wax 
 in the ear affected with catarrh, and the skin of the 
 canal, in these cases, is dry, scaly, and itching. This 
 induces the patient to scratch the ear, which act often 
 abrades the skin *of the canal and sets up boils and 
 abscesses and favors the growth of aspergillus (p. 51). 
 
 The drum-membrane now begins to lose its normal 
 translucent appearance, and as the chronic catarrh of 
 the ear advances it becomes opaque, dull, and looks 
 like ground glass. Sometimes, however, the drum- 
 membrane, instead of growing thicker under the in- 
 fluence of the chronic catarrh, becomes thinner, espe- 
 cially in atrophic forms of naso-pharyngeal catarrh. 
 When the membrane is thinned it transmits the pink 
 or even red color of the congested mucous membrane 
 of the drum-cavity, and consequently looks pinkish. 
 In many cases there are chalky spots on the drum, the 
 result of local points of inflammation, usually in the 
 inner coat of mucous membrane. In this country 
 
DISEASES AND INJURIES OF MIDDLE EAR. 103 
 
 chalk-spots on the drum-membrane are rare. They are 
 most likely to occur in the gouty and rheumatic, and 
 in individuals of European birth. I attribute the latter 
 fact to the universal habit of wine- and beer-drinking 
 in Europeans, and the consequent gouty tendency in 
 them. 
 
 Changes occur in the position of the membrana tym- 
 pani as the disease in the drum advances. Instead of 
 the hammer's being nearly vertical, it is drawn inward, 
 upward, and backward. This renders the malleus- 
 bone foreshortened, and the folds of the drum-mem- 
 brane with the short process of the hammer project 
 sharply outward. The pyramid of light may disappear 
 entirely, or appear broken and thrown upward. In 
 some cases the hammer-bone appears rotated on its 
 long axis, from the twisting force of the tensor tym- 
 pani muscle, which is constantly drawing it inward and 
 about the long axis of the handle of the hammer. 
 
 Local Flushing. — In some cases of chronic aural 
 catarrh the sympathetic nerve is implicated. This is 
 shown by the flushing which may occur on the neck 
 and chest on the side of the affected ear. This red- 
 dening or flushing is due to the temporary paralysis of 
 the vaso-motor nerves which control the calibre of the 
 blood-vessels in these regions. When they lose their 
 control over the vessels the latter become distended with 
 blood, and the aforesaid flushing ensues. Very often 
 pressure upon the side of the cervical vertebrae causes 
 pain in the shoulder and ear of the corresponding side, 
 and an increase in the fulness and singing in the ear. 
 In fact, it is very commonly found that women who 
 are neuralgic suffer from chronic aural catarrh, being 
 
104 DISEASES A AD INJURIES OF THE EAR. 
 
 deafer when afflicted with a neuralgic attack in the 
 head. This has given rise to naming such forms of 
 chronic aural catarrh nervous deafness. Women are 
 usually the subjects of this form of ear-disease, and are 
 generally worse periodically. 
 
 The Condition of the Nose in Chronic Aural Catarrh. 
 — The condition of the nose, both in front and in its 
 posterior parts, is of the greatest importance in chronic 
 catarrh of the middle ear. As the latter disease usu- 
 ally starts in the nose and goes into the Eustachian 
 tubes and drum-cavities, great attention must be paid 
 to their condition in cases of aural catarrh. We usu- 
 ally find a form of hypertrophic catarrh affecting at 
 first the mucous membrane covering the lower turbi- 
 nated bones. It may, however, from the outset affect 
 all the mucous membrane of the nose. The thicken- 
 ing or enlargement of the mucous membrane may ex- 
 tend to the back part of the lower turbinated bones 
 and form the so-called posterior hypertrophies. These 
 being near the mouth of the Eustachian tube endanger 
 its normal patulence and threaten the hearing. There 
 are often found in these cases enlargements and pro- 
 jections in the cartilage and bone of the septum or 
 partition between the nostrils. All of these growths 
 obstruct the air-passages and diminish the breathing- 
 space. This, of course, deprives the nose of its natural 
 stimulus, — the air; mucus collects, the swelling in- 
 creases, and the naso-pharynx is also shut off from its 
 important supply of respired air. This, in turn, de- 
 prives the Eustachian tube of air, and the middle ear 
 fails, in consequence, to get its ventilation at each act 
 of swallowing. Mouth-breathing then takes the place 
 
DISEASES AND INJURIES OF MIDDLE EAR. IQo 
 
 of nasal respiration^ the air of the drum-cavity not 
 being freely renewed^ a kind of vacuum is formed in 
 the middle ear, and the external atmosphere forces 
 the drum-membrane inward. In consequence of the 
 mouth-breathing, the tliroat gets dry and finally be- 
 comes sore. The inward tendency of the drum-head 
 carries with it the chain of ossicles, and, as the air does 
 not enter the drum-cavity freely, the bones are held in 
 an abnormal position, and may stiffen while thus held. 
 In such cases the deafness increases, and may become 
 irremediably impaired if relief is not soon given to 
 this unnatural position of the drum and the ossicles. 
 
 In the early stages of a nasal catarrh which affects 
 also the middle ear, the patient^s voice may sound 
 strange to him, and there may be cracking sounds in 
 it, which greatly distress and confuse him. This is 
 largely due to the fact that mucus from the back part 
 of the nose fills the mouth of the Eustachian tubes and 
 causes altered resonance, as it is termed, and the burst- 
 ing of bubbles or movements in the mucus occasion the 
 cracking sounds. After a cracking report in the ear 
 the nose may seem clearer and the hearing is better 
 temporarily. 
 
 Throat and Palate. — Turning our observation down- 
 ward into the throat, we may find the glands of the 
 back wall of the fauces enlarged. The tonsils may 
 also be enlarged, and at some points in them a gaping 
 mouth of a follicle is seen. In this opening there may 
 be a mass of white secretion, which is often mistaken 
 for an ulcer or a diphtheritic membrane. The appear- 
 ances in the throat, however, are not so constant an 
 attendant of aural catarrh as are the changes in the nose. 
 
106 DISEASES AND IX JURIES OF THE EAR. 
 
 The soft palate, or the velum, is often relaxed, and 
 the uvula generally is drawn to one side, mostly to- 
 wards the better ear. In some cases the uvula is swollen 
 and elongated, and tickles the throat, especially when 
 the patient lies upon the back. The palate when in 
 this condition is said to be paretic or partly paralyzed. 
 These changes in its appearance and position are due to 
 the effects of the catarrh of the mucous membrane upon 
 the muscle beneath it. The long-continued action of 
 the catarrh interferes with the contractility of the muscle 
 and renders it flaccid. This condition extends upward 
 and backward into the Eustachian tube, and thence 
 into the tensor tympani muscle. Hence a chronic 
 catarrh in the palate, posterior nares, and muscles of 
 the Eustachian tube finally induces a fatty degenera- 
 tion in the muscles of the parts named, and in the 
 tensor tympani muscle, which originates from one of 
 the muscles forming the soft palate. This muscle of 
 the drum then loses control of the membrana tympani, 
 and the position of the latter becomes abnormal, with 
 the result of a deterioration in hearing. The discharge 
 from the nose, both from in front and backward, into 
 the throat, may be copious at first. As the disease 
 advances, the nose becomes drier than normal, and 
 inspection reveals a hardening and contraction of the 
 mucous membrane in the nose. While the swelling in 
 the nose and discharge from it continue great, the 
 enunciation is nasal. When the changes in the palate 
 are marked, the vocal powers of the patient are im- 
 paired. Complaints are often made of the sensation 
 of having a hair in the throat at this period of the 
 disease. Reading aloud soon becomes painful, and 
 
DISEASES AND INJURIES OF MIDDLE EAR, 107 
 
 the voice breaks and cracks in singing. Hence public 
 speakers are not able to continue their work as for- 
 merly, and singers often cease to sing entirely, when 
 chronic aural and nasal catarrh is fully established. 
 If these symptoms appear in one ear first, as they 
 usually do, the other ear may soon become affected 
 from the same causes. This should be a great induce- 
 ment to have the catarrh treated as soon as it is known 
 that one ear is diseased, in order that the unaffected ear 
 may escape. Nothing is worse than neglect of the bad 
 ear because the other ear continues good. 
 
 Eastachian Tube, — If air is thrown into the Eusta- 
 chian tube by the surgeon's instrument, or when the 
 patient blows the nose forcibly, a crackling is caused 
 by the air passing through the mucus and the swollen 
 tube. 
 
 Near the mouth of the tube there is the so-called 
 pharyngeal tonsil, which is often diseased and en- 
 larged. In this condition it helps to occlude the 
 mouths of the Eustachian tubes and to aggravate the 
 catarrhal disease in the tubes and middle ears. Some- 
 times instead of this enlarged gland there are found in 
 this post-nasal region several large glands, shaped like 
 cocks' combs, or like cherries. In such cases there 
 wall be hawked into the throat from behind the nose 
 flakes of tough, greenish mucus. 
 
 Membrana Tympani. — When the secretion in the 
 naso-pharynx is copious, as in the early stages of 
 chronic aural catarrh, after inflation of the drum- 
 cavity, bubbles of air are seen behind the membrana. 
 This indicates the presence of mucus in the drum- 
 cavity. After the inflation productive of the appear- 
 
108 DISEASES AND INJURIES OF THE EAR. 
 
 aiice of these bubbles, the drum-membrane seems to 
 have a more normal position. Gradually, as the air is 
 reabsorbed in the drum-cavity, the bubbles disappear 
 and the drum-membrane is retracted. The mucus may 
 be gradually absorbed, but, if it is not, a puncture in 
 the drum-membrane permits it to escape, and the hear- 
 ing, which is usually impaired by its presence in the 
 ear, improves after the mucus escapes. When mucus 
 thus collects in the drum-cavity it may require more 
 than one lancing of the drum-membrane to effect a 
 cure. The latter is brought about by emptying the 
 drum of mucus and keeping it free. If one incision 
 will not suffice, the operation must be repeated until 
 mucus ceases to accumulate in the cavity behind the 
 membrana tympani. 
 
 Causes of Chronic Aural Catarrh. — As has been 
 said, the onset of this disease is often insidious : very 
 few patients can tell accurately when they first per- 
 ceived a change in their hearing or any premonitory 
 symptom. Generally a severe cold in the head marks 
 the time when the hearing began to be bad and the 
 noises in the head to cause annoyance. Very often, 
 after certain diseases, the ear has begun to show signs 
 of chronic catarrh. Among these promotive diseases 
 may be named phthisis; great sorrow and nervous 
 prostration ; progressive locomotor ataxia ; sciatica and 
 general neuralgia; neuralgia of the fifth nerve; in- 
 sanity; intemperance, and all forms of dissipation. 
 Chronic aural catarrh often follows pregnancy, change 
 of life, uterine diseases, continued and eruptive dis- 
 eases, mumps, shock from injuries, rheumatism, gout, 
 and syphilis. 
 
DISEASES AND INJURIES OF MIDDLE EAR. 109 
 
 In some instances the latter disease apparently pro- 
 duces great changes in the middle ear, and deafness. 
 This is due to the sudden and great catarrhal swelling 
 which syphilis induces in the mucous membrane of the 
 middle ear. It has very often been supposed that the 
 nerve of hearing is primarily affected in these cases. 
 But this is not so at first ; later on in the disease the 
 nerve may be secondarily affected. The deafness is 
 due to a swelling of the mucous membrane over the 
 little bones in the middle ear^ and the consequent 
 stiffening of their joints. It requires but little such 
 swelling about the stirrup-bone to cause impeded 
 vibration in it, and then follows quickly a profound 
 deafness. 
 
 Many cases of chronic catarrh of the middle ear are 
 traceable to sleeping on the ground and exposure in 
 camps. I have observed many of this form, attribu- 
 table to the hardships of our late civil w^ar. 
 
 Anglo-Saxons born in tropical countries seem liable 
 to the sclerotic form of chronic aural catarrh. I have 
 seen such forms of ear-disease in children born of 
 Anglo-Saxons in Mexico. 
 
 Hunting, if it brings with it a whetting of the legs 
 and body, is a cause of chronic catarrh of the middle 
 ear. Diving in the water, or ducking the head under 
 water habitually, also produces the same effects. Water- 
 dogs and retrievers who enter the water constantly 
 usually grow deaf from chronic catarrh of the middle 
 ear. Mill-hands, boiler-makers, and domestic cooks 
 seem liable to chronic catarrhal deafness. This is due 
 to the fact that mill-hands are exposed to the bad 
 effects of imperfect ventilation, dust, and irregular 
 
 10 
 
110 DISEASES AND INJURIES OF THE EAR. 
 
 meals, which are productive of debility and direct 
 irritation of the nasal mucous membrane and that of 
 the Eustachian tube and middle ear. 
 
 Boiler-makers are exposed to confined atmosphere 
 while at work, and also to great noises. These tend to 
 provoke catarrh, and to weaken the nerves of the middle 
 ear, to promote congestion in the drum-cavity, and 
 finally to strain the nerve of hearing. 
 
 Domestio coohs are exposed to great heat, and con- 
 sequently perspire freely. They also do other domestic 
 w^ork, like washing clothes, and go from a heated room 
 into a court to dry the clothes. This tends to produce 
 in them rheumatism and chronic catarrh in the head 
 and ears. These subjects furnish a large number of 
 cases of chronic catarrhal deafness. 
 
 Workers in submarine caissons are liable to exposure 
 to dampness and unusual atmospheric pressure when at 
 work. Such workmen constantly develop rheumatism, 
 chronic catarrh of the head and ears, with annoying 
 sounds in their ears, and great deafness. 
 
 Carpenters^ who are obliged to work in cold and 
 draughty houses, are frequently aflPected with catarrh 
 in the head, and finally, by neglecting their head-dis- 
 ease, grow deaf from chronic catarrh of the middle 
 ear. 
 
 Telegraph and telephone operators, if affected with 
 chronic catarrh of the middle ear, grow markedly and 
 rapidly worse if subjected to many hours of continuous 
 work. This is due to the exhaustion of the nerve- 
 power of the drum-cavity, the increase of the catarrhal 
 disease, and finally to a weakening in the auditory 
 nerve itself. 
 
DISEASES AND INJURIES OF MIDDLE EAR. m 
 
 Exposure to the concussion caused by the discharge 
 of heavy cannon in confined quarters, like a fort or a 
 casemate, induces a catarrhal condition of the mucous 
 lining of the middle ear, and deafness. This in time 
 brings on exhaustion of the auditory nerve, like the 
 continuous exposure of the ear to the shocks of a tele- 
 graph apparatus or of the telephone. 
 
 Hygiene of the Ear in Chronie Catarrh, — Since this 
 disease of the middle ear is usually slow and insidious 
 in its onset, the slightest warning, like fulness or noises 
 in the ear or ears, must not be disregarded. In fact, 
 as this disease is usually dependent upon catarrh of the 
 nose, when this latter affection is known to be present 
 the ears should be carefully watched by the patient, his 
 physician, and his nurse. As it often follows close upon 
 so many diseases, already named (p. 108), a patient af- 
 fected by any of these maladies should also be care- 
 fully watched. Those suffering from catarrhal deafness 
 should be extremely careful not to take cold. While 
 not exposing themselves, they must not house them- 
 selves too much, nor dress too warmly, inducing per- 
 spiration, in winter-time. Those who suffer from cold 
 feet should change their hose in the middle of the day, 
 putting on dry stockings in the place of those damp- 
 ened by perspiration. If possible, two pairs of shoes 
 should be in use, being worn on alternate days. This 
 insures a drying of shoes on the off-days. The under- 
 clothing should be of a kind to keep one warm in 
 wnnter-time in all ordinary weather. People vary 
 greatly in their requirements in this way. I always 
 advise some form of all-vjool undershirt, if it can be 
 worn. It may be very thick, or thin, according to the 
 
112 DISEASES AND INJURIES OF THE EAR. 
 
 needs of the patient. The drawers may be of wool, 
 merino, cotton, or silk, according to the necessity of the 
 case and the means of the wearer. If all-wool under- 
 shirts cannot be tolerated, then a mixture of silk and 
 wool, or stout merino, may be tried. It is preferable 
 that the same kind of material worn in winter should 
 be worn also in summer, — of course in much lighter 
 weights. This can easily be accomplished, because all 
 of the above-named kinds of underclothing come in 
 very light weights. If they cannot be purchased 
 ready-made of suitable weights for summer wear, very 
 thin flannel can be bought by the yard and made into 
 undershirts. The drawers in summer-time must usu- 
 ally be of the lightest materials. Patients with chronic 
 catarrh of the middle ear may take cold in summer- 
 time, and get deafer, just as easily as in winter, if not 
 properly clad. Those with a catarrhal tendency should 
 always wear in summer-time an undershirt thick enough 
 to protect them against the sudden changes which come 
 at any time with a shower. Hence a so-called gauze 
 undershirt should never be worn by a patient with 
 chronic nasal and aural catarrh. For him to dress 
 warm enough for safety in summer-time may at times 
 make him too warm for a little while in the middle of 
 the day. But he may lighten outside clothes to make 
 up for this. He had better be a little uncomfortable 
 for a few hours than to take cold from a sudden change 
 in temperature. It is much better to feel too warm 
 for a while than to even feel chilled in summer-time, 
 when the skin is always acting very freely. Checking 
 the perspiration at such time is the cause of nearly all. 
 the bowel-catarrhs of summer, and is the cause of 
 
DISEASES AND INJURIES OF MIDDLE EAR. 113 
 
 numerous cases of catarrh of the middle ear. If the 
 latter disease is ah^eady established^ the patient gets 
 much worse by carelessness in dressing in summer. 
 
 Underclothing should always be worn at night. 
 The night-undershirt should go on with the night- 
 shirty the day undershirt coming ofl' with the day- 
 clothing. In summer-time this may be of the lightest 
 type. In winter-time the night-undershirt should be 
 lighter than the kind worn in daytime, except in very 
 cold weather, when the same weight may be worn, if 
 desired, both at night and in daytime. If the feet are 
 cold in bed, light stockings or socks should be worn. 
 We have great extremes of temperature in this country, 
 and we must dress accordingly. 
 
 Ventilation, — The question of ventilation of the 
 sleeping-apartments of those suffering from chronic 
 catarrh of the middle ear is very important. In 
 summer-time one can hardly get too much air, unless 
 the weather happen to be decidedly cool. Our good 
 sense and our feelings must often be the guide. A 
 strong draught of cool air is never safe for any one : 
 for one with catarrh of the head and ears it is danger- 
 ous. In winter-time no one should feel cold in bed. 
 Renewal of the air in a bedroom can easily be had 
 and must be secured without chilling the patient or 
 any one else. If the apartment is large and not m a 
 densely-crowded city street, it is much easier to make 
 it too cool and draughty than too close. If the patient 
 sleeps alone, it will not be easy to make his bedroom 
 too close or too warm in winter-time. In fact, a ca- 
 tarrhal patient should never feel a draught nor a sensa- 
 tion of great cold on his head at any time, especially 
 h 10* 
 
114 DISEASES AND INJURIES OF THE EAR, 
 
 at nighty when in bed. In daytime he cannot get too 
 much air, if he takes it in the right way. The apart- 
 ments occupied in daytime, whether offices, boudoirs, 
 school-rooms, or places of manual work, should be well 
 ventilated. They need not be draughty, in order not 
 to be ^^ stuffy.^^ The air breathed, especially in schools, 
 is often permitted to get foul while trying to keep the 
 pupils warm. This can be obviated, not by opening 
 windows at the top or bottom, but by some simple 
 form of adjustable ventilator to be placed in the win- 
 dow. This will effect a purification of the air, without 
 chilling any one or exposing those near the window to 
 a draught. Children with chronic catarrh of the nose 
 and ears are often made worse by breathing the effete 
 air of a school-room for long periods, and then some- 
 times they are suddenly chilled by having the windows 
 thrown open when the rooms become insupportably 
 close. Both of these extremes are injurious to all, — 
 especially so, however, to the catarrhal patient. The 
 air of artists' studios is sometimes quite impregnated 
 with the fumes of turpentine and paint. This has 
 been known to excite and congest the catarrhal nose 
 and ears and make them worse. All such fumes must 
 be avoided by those affected with catarrh of the nose 
 and middle ear, if it seems to injure them in even a 
 slight degree. The air of all apartments is rendered 
 purer by a fire in an open fireplace, even when not 
 sufficient nor required for warmth. 
 
 Exercise. — Walks or rides are far preferable to drives, 
 as an exercise or for taking an airing. Fresh air and 
 exercise, or exercise in the fresh air, should be the 
 guiding motto for all of us, but especially for any one 
 
DISEASES AND INJURIES OF MIDDLE EAR. US 
 
 with catarrhal disease in the head and ears. Exer- 
 cise, however, must never be carried beyond a healthy 
 fatigue. Exhaustion in this respect, as in any other 
 pursuit or pastime, would inevitably make the ear- 
 disease worse. 
 
 In summer-time exposure to the direct rays of the 
 sun to any great extent would be likely to make the 
 ears worse, by inducing congestion in them. In winter- 
 time the ears need not be protected from the cold air 
 unless exposure to the cold brings on earache. Then 
 a little cotton may be placed in the mouth of the canal 
 of the ear, while in the open air, — never in the house. 
 
 Mouth breathing must be most carefully avoided, 
 and the nose forced to do its work as a respirator. If 
 exercise in the open air has produced considerable per- 
 spiration, the patient must not cool off suddenly by 
 standing or sitting in the open air. The exercise may 
 be lessened, or a slow walk made to substitute the rapid 
 one. Sitting down must be deferred until in the house 
 or in a covered vehicle. It is only safe to have some 
 additional wrap to throw on after the exercise is lessened, 
 whether in winter or in summer. 
 
 When quitting warm places of amusement, or any 
 warm apartments, in winter evenings, an extra wrap 
 should be put on unless the wraps worn to such places 
 have been taken off while there. It is also safer to 
 breathe at first through a handkerchief, or the like, 
 upon going into the cold air of a street at night after 
 leaving warm apartments. Many of these suggestions 
 may seem, or be, burdensome ; but, as the hearing may 
 depend upon them, they are worthy of our consideration. 
 
 As a severe cold in the head in one affected with 
 
116 DISEASES AND INJURIES OF THE EAR. 
 
 chronic aural catarrh may make the hearing perma- 
 nently much worse^ everything which can be done to 
 ward off the cold should be carefully attended to. 
 
 Low slippers should never be worn about the house 
 in winter-time, nor even in one's bedroom in very cold 
 weather. The low slipper exposes the top of the foot 
 and the ankle to the cold of the floor, and gives many 
 people cold in the head which they cannot account for. 
 Light shoes or boots should be worn about the house, 
 and high, loose, fleece-lined slippers in the bedroom, 
 when the weather is cold. The knitted bedroom slipper 
 is very good. Neither the bare foot nor the feet encased 
 in stockings should be placed upon the floor in winter- 
 time. There is an intimate sympathy between the feet 
 and the throat, nose, and ears. I have known the ex- 
 posure of the feet even on carpeted floors, in winter- 
 time, to give a severe cold in the head, and to be followed 
 by a marked increase in deafness. Constant watchful- 
 ness and care in this particular is the price the patient 
 with aural catarrh should willingly pay to retain his 
 hearing. 
 
 If these little exposures, as some may call them, are 
 followed by bad consequences in the deaf, it would 
 seem unnecessary to caution the patient against greater 
 ones. Yet the young often expose themselves to in- 
 tense cold, in sleighing-parties, and to cold wetting by 
 wading in snow or in inordinate coasting. I have 
 known walking a few blocks in deep snow, and then 
 sitting in a car or carriage for a half-hour with the 
 wet clothing still on, to produce a severe cold in the 
 head, followed by great and permanent deafness, in 
 those already affected with aural catarrh. But even 
 
DISEASES AND INJURIES OF MIDDLE EAR. 117 
 
 in the perfectly healthy such exposure may lay the 
 foundation of chronic catarrh in the ears and deafness, 
 and therefore should be most sedulously avoided. 
 
 Bathing, in all its forms, in the performance of the 
 toilet, becomes an important matter for consideration, 
 especially in the case of those affected with chronic 
 catarrh of the middle ear. We should all bathe in 
 winter-time simply for the sake of cleanliness, and not 
 as a matter of pleasure. The latter is not to be thought 
 of in cold climates, in winter-time. The bath should 
 always be taken in a warm bath-room (70° F.), in 
 cold weather, the temperature of the water being regu- 
 lated by the feelings of the bather. It is always 
 safest to bathe in the evening, in winter-time, and then 
 go to bed in a warm room. 
 
 Bathing in cold rooms in cold water in winter-time 
 never does any one any good ; and in the case of pa- 
 tients with chronic aural disease it does positive harm. 
 Many such patients who have been indulging in cold 
 sponge-baths, with the idea of hardening themselves, 
 have been improved at once in health and hearing by 
 stopping their cold-water bathing. In any case, once 
 a week is quite often enough for a full warm bath in 
 winter-time. If the bath-night fall on a very cold 
 night, the bath should be postponed to milder weather. 
 
 The feet, neck, and face may be washed as desired in 
 all kinds of weather, if they are carefully dried after 
 the bath. Tepid water is preferable in winter-time, 
 especially in the deaf, and the neck must not be exposed 
 too low, and never in a cold room while performing the 
 toilet. The nerves going up on the sides of the neck 
 are intimately connected with the ears, and the latter 
 
118 DISEASES AND INJURIES OF THE EAR. 
 
 are injured if these nerves are unduly chilled by im- 
 prudent bathing, at any season. 
 
 Equal caution must be observed in washing the hair 
 (p. 84) as in washing and bathing the body. Ladies 
 and children are especially exposed to the dangers of 
 ear-disease and deafness from imprudent washing and 
 deficient drying of their hair. In them the hair is 
 much longer and denser than in men, who nowadays 
 wear their hair very short. 
 
 The danger in hair-washing consists in the subse- 
 quent imperfect drying, and the consequent evaporation, 
 which may go on for hours, lowering the temperature 
 of the head and often inducing most severe colds in the 
 head, ear-catarrh, and deafness. 
 
 Clothing. — In regard to clothing there is little to be 
 said to men : there is much to be said to women, how- 
 ever, on this score. If there is any catarrhal tendency 
 in the head and ears, tight lacing, by impeding the 
 circulation of the blood in the large vessels of the 
 body, interferes with the circulation in the head and 
 induces a passive congestion of the nose and the ears. 
 This of course keeps up a catarrhal inflammation in 
 these parts, and makes the deafness worse. Women 
 also make a mistake in varying the weight of their 
 clothing in winter-time, a heavy outfit of daytime 
 being substituted for a light one in the evening, in 
 accordance with the exigencies of society. This sudden 
 alteration both in the cut and in the weight of the 
 dress often brings with it severe colds and establishes 
 chronic catarrh of the head and ears. If great changes 
 in the weight and style of the clothing are made in 
 winter-time, ample protection should be given to the 
 
DISEASES AND INJURIES OF MIDDLE EAR. HQ 
 
 neck and shoulders, by extra wraps, while passing from 
 the house to the ball-room, and upon returning home 
 again. The danger, however, of such changes in 
 clothing is very great in one already affected with 
 catarrhal disease in the ears. 
 
 There is also a carelessness on the part of many 
 young women regarding the wearing of warm under- 
 clothing in winter. Many will wear none at all, and 
 thus some find themselves suffering from muscular 
 rheumatism. If there is any tendency to catarrhal 
 disease in the ears and hardness of hearing, the chest 
 and shoulders must be well protected by an undershirt 
 which comes high up in the neck. It is needless to 
 say that such an undershirt must not be laid aside in 
 order to wear a low-necked dress, in cold weather. 
 Such an act would endanger not only the hearing, but 
 also the general health. 
 
 Those affected with catarrhal deafness must be as 
 careful with their feet as with their necks and chests. 
 If slippers are worn to the evening party or ball, the 
 feet must have additional protection in transit to and 
 from the ball-room. 
 
 Our bodies in health contain heat and electricity. 
 If they get chilled or wet, the heat and electricity 
 escape quickly, and vitality is lowered, especially at 
 night. The body then becomes an easy prey to disease. 
 We easily get fevers and catarrhs of all kinds. Promi- 
 nent among the latter are the catarrhs of the throat, 
 head, and ears. Therefore we must be careful not to 
 expose our bodies to too much cold in winter, nor to 
 much wetting, as in washing and bathing. If we err 
 in this respect, through carelessness, we lose our body- 
 
120 DISEASES AND INJURIES OF THE EAR. 
 
 heat and electricity and pay the penalty, as above, in 
 impaired health and hearing, or in other ways. If 
 there is any tendency to deafness, the above-named 
 cautions must be observed if recovery is desired. 
 
 While these cautions are imperative in winter-time, 
 they must not be disregarded in summer. Many cases 
 of severe and irremediable ear-disease have resulted 
 from sleeping with very little clothing, by a window, 
 or on the floor in a draught. In the country, especially 
 in mountainous regions, the radiation of heat from the 
 earth is great, especially between midnight and sunrise. 
 Any one sleeping near an open window, or with his 
 head on the sill of an open window, will at such a 
 time incur the risk of a chilling of the head and neck. 
 This endangers the welfare of the ears, and, as a matter 
 of fact, has produced severe congestions in the head, 
 followed by disease of the ears and deafness. Some 
 forms of tumor in the brain, involving the auditory 
 nerve, have been traced to this kind of careless expo- 
 sure of the head to the damp coolness of the night-air 
 in mountain-districts. 
 
 Food and Drink, — Those who suffer from catarrh 
 of the ear and deafness must not eat highly-seasoned 
 food nor drink alcoholic beverages, since both of these 
 agents excite further congestion in the head and ears. 
 Many such patients are made immediately worse by a 
 drink of wine or spirits, or even by a meal of highly- 
 seasoned food. It is not the province of this little 
 book to consider the moral side of these acts, but the 
 author cannot avoid saying most emphatically that it 
 is usually a physiological misfaJcej or sin, to indulge in 
 highly-seasoned food and strong drink. 
 
DISEASES AND INJURIES OF MIDDLE EAR. 121 
 
 If dyspepsia is produced and the bowels become con- 
 stipated or sluggish, the catarrh in the ears is always 
 rendered worse. As indulgence in food and alcoholic 
 drinks inevitably tends to diseases of the digestion, too 
 great caution in this respect cannot be observed by all, 
 but especially by the patient with catarrhal deafness. 
 
 Large doses of quinine and salicylic acid tend to 
 produce congestion of the head and ears, and hence 
 make catarrhs of these parts of the body worse. These 
 drugs should, therefore, be used with great caution by 
 those affected with aural disease. 
 
 Use of Tobacco, — Moderate smoking of tobacco in 
 any form — i.6., the equivalent of three cigars a day — 
 will not injure the patient in chronic catarrh of the 
 ears, if no smoke is blown through the nose or inhaled 
 into the lungs. Pipe-, cigar-, and cigarette-smoke are 
 equally harmless if used in great moderation and not 
 exhaled through the nose. Tobacco-chew^ing is an un- 
 clean practice, and may irritate the throat and hence the 
 ears. It can never be entirely free from danger to those 
 with catarrhal ear-disease. 
 
 Snuffing tobacco is very injurious to the ears, because 
 it is a direct irritant to the nose, and thence to the 
 Eustachian tube and the ears. Good ears and hearing 
 are generally found in those with good health. Most 
 cases of ear-disease and deafness are due to carelessness 
 and neglect of the laws of health. They improve or 
 recover if the disease is not too far advanced, when 
 advice is finally sought and followed. 
 
 When an individual already affected with chronic 
 catarrh of the middle ears finds that he has taken cold 
 in his head, and consequently feels deafer, he must not 
 
 F 11 
 
122 DISEASES AND INJURIES OF THE EAR, 
 
 make the very common mistake of prescribing for him- 
 self large doses of quinine, to '' break the cold/^ as it is 
 erroneously termed. Such patients should take no qui- 
 nine at the beginning of a fresh cold, for reasons already 
 given (p. 75). If there is marked debility as the cold 
 passes off, perhaps as much as four to six grains daily 
 may be given as a tonic. 
 
 The best course for such a patient to follow is to stop 
 all local treatment of the nose, if he has been applying 
 any, and seek the advice of his physician. The author 
 believes that housing in a warm room in the early stages 
 of a cold in the head is the surest step towards prompt 
 recovery. 
 
 Colds in the head, especially in those already affected 
 with chronic aural catarrh, should be treated like fevers. 
 The patient should remain in his room, or even in bed, 
 if the fever is high, and his diet should be low. 
 
 As highly-seasoned food, meats, game, etc., tend to 
 congest the head even in health, they must be left en- 
 tirely out of the diet of any one with an acute cold in 
 the head. There is no worse treatment than '^ feeding 
 a cold.'^ It must be starved out. Very little medicine 
 will be required at first. Bromide of potash in small 
 doses every half-hour or hour will quiet the pulse and 
 lessen the irritation in the nares and fauces. If the 
 throat is sore, lozenges of chlorate of potash will re- 
 lieve it. 
 
 It is a mistake to drink hot toddies or any form of 
 hot drink, in order to promote perspiration, in the early 
 stages of a head-cold. They are more likely to further 
 accelerate the pulse and congest the head and ears. In 
 any event they may excite too much perspiration and 
 
DISEASES AND INJURIES OF MIDDLE EAR, 123 
 
 give more cold, especially if the patient goes out soon 
 after drinking them. Rest in a warm room or in bed 
 will produce enough warmth of the skin to insure 
 sufficient perspiration. It is never well to take the 
 body by storm in our remedies. We must gently per- 
 suade the system back to health, from which, too often, 
 we have driven it by rough and careless mismanage- 
 ment. 
 
 In the early stages of a cold in the head, sneezing 
 and blowing the nose should be avoided as far as possi- 
 ble, as they tend to tear the mucous membrane and 
 further congest it, thus making the cold, which is an 
 inflammation in the nose, much worse. Sneezing may 
 be suppressed by pressing the upper lip and holding 
 the nose, best accomplished by pressing a handkerchief 
 over these parts, as is done in the act of blowing the 
 nose. By keeping back sneezing, a cold may be made 
 much less severe, and in some cases it would seem that 
 by avoiding sneezing at the outset, a cold in the head 
 is aborted at once. Blowing the nose can be avoided 
 very easily, and if not indulged in will hasten the 
 cure. If the nose runs, it should be lolped, not blown. 
 
 Treatment — The proper and successful treatment of 
 chronic catarrh of the middle ear cannot be prescribed 
 and carried out by any one but a skilful physician. 
 A careful examination should first be made, and then 
 a diagnosis can be established. After this is done, the 
 treatment may be carried out partly by the physician 
 and partly by the patient or his nurse. 
 
 The rules of hygiene already laid down must be 
 carefully followed by the patient, and this is often all 
 the patient can do. The actual local treatment, like 
 
124 DISEASES AND INJURIES OF THE EAR. 
 
 the minute scientific examination^ of the ear, can be 
 done only by an expert. 
 
 In chronic catarrh of the middle ear, no treatment 
 carried on through the external ear, like drops or other 
 applications to the outside of the drum-membrane, 
 will do any good. This may be set down as an abso- 
 lute and fixed law. If any benefit is to come from 
 treatment, the latter must be applied to the nose and 
 Eustachian tube where the catarrhal disease began. In 
 this way only can the middle ear be reached and the 
 deafness arrested or cured. The disease is a swelling 
 in the mucous membrane of the parts just named, 
 which induces a want of air in these cavities, £^nd a 
 collapse of the drum and deafness are the results. The 
 first step, therefore, is to reduce this swelling and 
 restore air to the drum-cavity. 
 
 Applications to the Nose. — The first endeavor should 
 be to reduce the swelling in the nose and Eustachian 
 tube by sprays thrown into the anterior nostrils from 
 hand atomizers. These sprays must not be very dense, 
 or they will do more harm than good. If the fluid 
 used to make these sprays is denser than the blood, it 
 is too strong, and draws the fluids of the tissue out, — 
 i.e., it practically squeezes thein, — causing pain and 
 distress. If it is rarer, or thinner, than the blood, it 
 is absorbed quickly and in large quantities, the already 
 swollen tissues in the nose and Eustachian tube become 
 puffed up, the swelling is thus increased, and the disease 
 is made worse. In such cases as the latter, the nasal 
 breathing may become impeded by the treatment, and 
 then the patient will be forced into the very injurious 
 resource of mouth-breathing, which, as already stated, 
 
DISEASES AND INJURIES OF MIDDLE EAR. 125 
 
 is bad for the throat (p. 97). Every case must, there- 
 fore, be examined before any treatment is applied to 
 the nose, and a spray selected best adapted to meet the 
 requirements of the affection in the nose and middle 
 ear. In some cases applications to reduce the swelling 
 of the nose and Eustachian tubes have to be made by 
 means of cotton tufts on probes, carried to the diseased 
 tissues. 
 
 The sprays must pass back until they are felt coming 
 into the throat or mouth. This need not be felt in 
 large quantities, as it is not well to flood the back part 
 of the nose with any form of fluid. 
 
 If offensive catarrh is met in a case of chronic ear- 
 disease, the spray used must be more stimulating than 
 that used in what is the more common form, the so- 
 called hypertrophic (increased growth) catarrh of the 
 nose. The offensive form of catarrh is known as the 
 atrophic kind. The latter variety is characterized by 
 a loss of tissue, a cessation of proper growth in the 
 structures of the mucous membrane, and hence receives 
 the name of atrophic. 
 
 It would be impossible and unnecessary to set forth 
 here a minute course of treatment in various forms of 
 catarrh of the nose and ear. It may suflBce to say that 
 in the first-named form (the hypertrophic), the most 
 common variety of nasal and aural catarrh, the follow- 
 ing solution sprayed into the anterior nostrils will be 
 beneficial : 
 
 R Sodii bibor., gr. x; 
 
 Sodii bicarb., gr. vi ; 
 
 Acid, carbol. , gr. i ; 
 
 Glycerinae, fgii ; 
 
 Aquse, q. s. ad f§iv. M. 
 11* 
 
126 DISEASES AND INJURIES OF THE EAR, 
 
 In the atrophic form, the so-called ozsena, which is 
 attended with a bad odor in the breath, a spray of the 
 following solution may be used : 
 
 R Sodii bicarb., gr. xx ; 
 Acid. carboL, gr. iv ; 
 Glycerinse, f^ii ; 
 Listerini, f ^i ; 
 Aquae, f^iii. M. 
 
 It may be said of these sprays that they will do no 
 harm, but be beneficial to some extent in the diseases 
 for which they are recommended. They will not be, 
 however, all that is required to produce the best results 
 possible in any given case. In order to accomplish the 
 most good, each case must be watched and conducted 
 properly by changing the treatment from time to time, 
 as the disease demands and as improvement goes on. 
 
 Inflation, — After sprays have been applied to the 
 nose, and have reached the back part of the upper 
 throat, some form of inflation of the ear may be used. 
 The simplest way to accomplish this aeration of the 
 middle ear is to hold one^s nose and with the lips firmly 
 closed force the breath up into the head and ears. 
 This is easily done by many, and the result of the act 
 is to hear a cracking and feel a fulness in the ears there- 
 after. Usually a temporary improvement in hearing 
 is experienced after this form of inflation of the ears. 
 It forces blood, however, into the head, and is not to 
 be recommended for frequent use or if any other means 
 of inflation can be commanded. It should not be used 
 more than two or three times a week. 
 
 Politzer^s method of inflation by means of a rubber 
 
DISEASES AND INJURIES OF MIDDLE EAR. 127 
 
 bag held in the hand is much better and safer, as it 
 does not force blood into the head, as the first-mentioned 
 form, the Valsalva method, does. In order to carry 
 out Politzer's method of inflation, a swallow of water 
 must be taken at the moment of inflation, or the same 
 effect may be obtained, in many cases, by a simple dis- 
 tention of the cheeks with breath. 
 
 Eustachian Catheter, — Inflation by means of the 
 catheter can be performed only by a surgeon. This 
 operation consists in passing a silver or a hard-rubber 
 catheter through the nose, and turning the beak of the 
 instrument into the mouth of the Eustachian tube. 
 While in this position, air is blown through it from a 
 rubber bao; held in the suro-eon's hand. The ear of 
 the patient is at the same time connected with the ear 
 of the surgeon by an auscultation- or listening-tube 
 made of soft rubber. By this means the surgeon can 
 hear whether the air passes into the catheter, and what 
 kind of sounds it makes on its way, whether moist and 
 bubbling from the presence of mucus in the Eustachian 
 tube or dry and whistling from the drying and narrow- 
 ing of the Eustachian tube. 
 
 A modification of the Eustachian catheter, consistino^ 
 of stopping the distal end, and perforating the sides of 
 the instrument near the end with numerous small holes, 
 supplies a means of conveying fluid medication directly 
 to the mouth of the Eustachian tube. Fluids should 
 not be forced into the drum-cavity through the Eu- 
 stachian tube, in cases of chronic catarrh of the middle 
 ear. The result of such medication is usually an acute 
 inflammation in the drum, with pain. 
 
 The tonsils, if enlarged in a case of chronic catarrh 
 
128 DISEASES AND INJURIES OF THE EAR, 
 
 of the middle ear, do not require cutting out or excision 
 as a means of cure of the deafness. It may be demanded 
 for other reasons, but not for remedying the ear-dis- 
 ease, because the latter is not dependent upon the ton- 
 sillar disease. In any event, wholesale excision of 
 these glands is rarely practised by the leading throat- 
 surgeons of the day. It is always a barbarous and 
 bloody operation, followed by symptoms of grave de- 
 pression of the health in many instances. As it is 
 never really required, it ought to be banished from the 
 surgery of the present. If some of the component 
 glands of the tonsil are diseased, or if portions of the 
 fibrous bed in which these lie are enlarged and thick- 
 ened, they may be excised ; but reflection should teach 
 the surgeon that all the glands, healthy and diseased 
 parts alike, should never be removed in a rash and 
 wholesale manner. The danger of copious hemorrhage 
 alone should prohibit the ghastly operation so often 
 done upon these glands, usually innocent of any causa- 
 tive part in the deafness. 
 
 If the uvula is elongated,— " the palate down,^^ as 
 it is called, — the redundant mucous membrane at its 
 tip may be snipped off with scissors made for the pur- 
 pose. But care must be taken not to cut away any of 
 the muscular tissue in the uvula. No operation on it 
 should be performed until it is ascertained that local 
 treatment by washes, gargles, etc., are unable to con- 
 tract it. It is a great mistake, just as much as the 
 entire excision of the tonsils, to cut off the entire uvula. 
 It causes an intense sore throat, with often serious fever 
 and other constitutional symptoms. It is furthermore 
 a valuable valve, and adjuvant to the palate in cutting 
 
DISEASES AND INJURIES OF MIDDLE EAR. ]29 
 
 off the throat from the nose in the act of swallowino; 
 food and drink. In some cases, were this impor- 
 tant part of the palate cut off, regurgitation of food 
 would ensue through the nose. Fortunately, this rude 
 surgery of the uvula is not as frequent as formerly. 
 But there are people still living who have under- 
 gone unnecessarily an entire amputation of the uvula. 
 The accounts of their subsequent discomforts might 
 well make any one hesitate to perform such an opera- 
 tion, when a gargle or some astringent application to 
 the throat would have cured the patient promptly and 
 painlessly. 
 
 Gargles, — The throat can often be greatly benefited 
 by gargling, and the effect of the motion of this form 
 of treatment, upon the muscles of the palate, has a very 
 good effect upon the muscular structure of the Eusta- 
 chian tube and middle ear. The inflammation in the 
 mucous membrane of the throat is thus allayed, and 
 the atony of the muscles in the Eustachian tube and 
 the middle ear is overcome. By this means the tube 
 opens more frequently and promptly and the drum- 
 cavity gets more air. This permits free vibrations of 
 the drum-membrane and the ossicles, and the hearing 
 improves. 
 
 Applications of nitrate of silver should not be made 
 to the throat or nose, as the tendency of this drug is 
 at last to produce an atrophy in the mucous membrane 
 and thus lay the foundation for offensive catarrh. 
 
 Gargles of solutions of chlorate of potash, sumach- 
 berries, and tannin are among the best for the purposes 
 we are considering. 
 
 The following formula makes an elegant gargle : 
 
130 DISEASES AND INJURIES OF THE EAR. 
 
 R Glycerite of sumach berries, 
 
 Tincture of pomegranate bark, of each, f^^iv; 
 Comp. infusion of roses, enough to make a pint. 
 
 A mouthful of this once or twice a day may be used 
 in chronic catarrh of the throat and middle ear. 
 
 In some cases, applications to the drum-cavity may 
 be required ; this, however, is very rarely the case. 
 The more usual demand is for applications to the Eu- 
 stachian tube (p. 107) and the naso-pharynx. Much 
 more frequently the cure of chronic catarrh of the 
 middle ear demands an operation on the drum-mem- 
 brane or upon the little bones within the drum-cavity. 
 If fluid matter accumulates behind the membrana 
 tympani, it must be got out. This is to be done either 
 by an incision in the drum-membrane or by forcing or 
 drawing it down the Eustachian tube into the throat. 
 The first method is the quickest, the surest, the easiest, 
 and the least annoying and painful to the patient. 
 This can be done only by an expert hand, under good 
 illumination of the drum by means of light reflected 
 from the mirror held upon the surgeon's forehead. It 
 is not painful, and generally gives immediate relief to 
 the sense of fulness in the ear, and to the deafness. 
 Sometimes fluid can be forced from the drum-cavity 
 by means of some of the forms of inflation already 
 mentioned, without resorting to incision of the drum. 
 
 For many years it has been known that when the 
 Eustachian tube is swollen or closed, the drum-mem- 
 brane out of place, and deafness has ensued in conse- 
 quence, an incision in the drum-membrane improves 
 the hearing as long as the perforation of the drum can 
 be maintained. But these artificial perforations in the 
 
DISEASES AND INJURIES OF MIDDLE EAR. I3I 
 
 drum heal very quickly, and then the dulness of hear- 
 ing returns. The search of the aurist has therefore 
 been for some method of makino; and retainino; a hole 
 in the drum-membrane in cases of chronic catarrh of 
 the middle ear. 
 
 Within the last ten or twelve years, through the re- 
 searches and operations of Schwartze in Germany and 
 of Sexton, of New York, aurists have learned that a 
 hole may be in most instances maintained in the drum 
 by excision of the membrana tympani and the malleus 
 and incus bones. By this means sound can enter the 
 drum-cavity more readily. As the two little bones 
 named above are generally the partial cause of the 
 deafness, by reason of their stiffening and preventing 
 the innermost one (stapes) from vibrating, their re- 
 moval in this operation has a further tendency to im- 
 prove the hearing in cases of chronic aural catarrh. 
 After this operation there is usually no inflammatory 
 reaction. The waves of sound being now better able to 
 enter the drum-cavity and fall directly on the stapes 
 bone, in the oval window, and upon the membrane of 
 the round window, the hearing is more or less im- 
 proved by the operation. If adhesions between the 
 drum-membrane and the inner wall of the drum-cavity 
 have been the cause of deafness, noises in the head, 
 and dizziness, this operation brings great relief. So 
 far as concerns the noises in the ears and the dizziness, 
 it is possible to effect an entire cure by this operation. 
 
 Aurists of most experience have concluded that efec- 
 tricity applied to the ears is unable to quiet the noises 
 in the ears and head, and impotent to remove the 
 deafness, in chronic aural catarrh. 
 
132 DISEASES AND INJURIES OF THE EAR. 
 
 It is possible in a work like this to present only an 
 outline of wliat may be done for chronic aural catarrh, 
 and not how to do it. It is also within the scope of 
 this book to indicate that some forms of treatment are 
 useless. 
 
 CHAPTER III. 
 
 DISEASES AND INJURIES OF THE INTERNAL EAR: 
 THE DEAF AND DUMB. 
 
 Diseases and Injuries of the Internal Ear. 
 
 Diseases of the internal ear are comparatively rare. 
 They consist in a lesion of the auditory nerve, and are 
 characterized by profound deafness. Their diagnosis 
 and treatment are difficult. They are caused by some 
 diseases, like typhoid fever, cerebro-spinal meningitis 
 (spotted fever), and chronic aural catarrh, and by inju- 
 ries to the head from blows and falls, and by direct 
 violence to the ear, as by noises near the auricle, con- 
 cussions, and by the insertion of slender objects down 
 the auditory canal into the drum and the internal ear. 
 
 The chief symptom of disease of the internal ear 
 and the auditory nerve is profound deafness. The 
 latter symptom is always sudden if the disease is due 
 to an injury to the head or the ear, as in blows or con- 
 cussions, or if induced by a fever. It comes on slowly 
 when it is the result of a chronic catarrh in the middle 
 ear, or of a tumor in the brain. 
 
 Among the rarer primary causes of disease of the 
 
DISEASES AND INJURIES OF INTERNAL EAR. 133 
 
 internal ear may be mentioned anomalies in formation, 
 ansemia and hypersemia^ and inflammation of the soft 
 parts of the labyrinth. 
 
 Secondary causes of disease of the internal ear are con- 
 cussions^ convulsions, typhoid and intermittent fevers, 
 apoplexy, and syphilis. Also cerebro-spinal meningitis, 
 mumps, eruptive fevers, skin-diseases, and the puerperal 
 state may induce disease of the internal ear. 
 
 The severest injuries, like fracture of the skull, 
 usually result in death. If the patient should survive 
 such an injury, there is every reason to believe he would 
 be deaf, because post-mortem examination in such cases 
 reveals injury of the labyrinth and auditory nerve com- 
 petent to produce entire and irremediable deafness. 
 Severe blows and falls on the head, not productive of 
 fracture of the skull, are often followed by profound 
 deafness in one or both ears. 
 
 The writer was once consulted regarding the case of 
 a boy who, while trying to stand on his head, had al- 
 lowed his weight to come suddenly on the top of his 
 skull. This accident was followed by symptoms of 
 meningitis, from which the boy finally recovered ; but 
 he remained profoundly deaf. 
 
 In another case, a gentleman was thrown from his 
 horse, and fell upon his head. He was stunned, and 
 remained unconscious for some time. Upon recovering 
 his consciousness he perceived that he was entirely deaf 
 in his left ear, and he has so remained. 
 
 In another case, a boy was struck on the ear by a 
 hard snow-ball. He became entirely and permanently 
 deaf in that ear. A ^^ box on the ear'^ may have the 
 same bad effect on the auditory nerve. The record of 
 
 12 
 
134 lyiSEASES AND INJURIES OF THE EAR, 
 
 such accidents is very large, but the recital of these few 
 will suffice to show the result of severe concussion upon 
 the auditory nerve, and to impress upon us the great 
 need of caution in avoiding such violence to our ears. 
 
 The accidental but forcible entrance of a slender 
 object, like a wire, a twig, or a pencil, down the audi- 
 tory canal and into the drum- cavity, where it has in- 
 flicted a wound upon the ossicles and the oval window, 
 has been followed by symptoms of injury of the in- 
 ternal ear and auditory nerve. This should warn 
 every one against the bad habit of picking and scratch- 
 ing the ear with any slender instrument which might 
 be forcibly pushed too far down the canal and produce 
 these bad results. Soldiers and sailors, who are ex- 
 posed to long-continued firing of cannon or to an ex- 
 plosion, often suffer from concussion of the nerve of 
 hearing. The same bad effect may be experienced 
 from exposure to weaker sounds nearer the ear, like a 
 shout or a kiss in the ear. Children thoughtlessly may 
 thus injure their parents' hearing, as has been recorded 
 by some observers. 
 
 The ear should never be exposed to intense noises of 
 any kind, if it can be helped. A strain may thus be 
 put upon the auditory nerve which may prove very 
 injurious. There are, in fact, especially in cities, many 
 avoidable noises which should be more stringently sup- 
 pressed. The writer has great sympathy with that 
 society in London having for its object the suppression 
 of unnecessary and useless noises. 
 
 A sound is a form of blow upon the brain. If it 
 assumes the nature of a noise, it becomes a hard blow 
 upon the nerve of hearing and the brain, and may be 
 
DISEASES AND INJURIES OF INTERNAL EAR. 135 
 
 followed by serious consequences. That the brain 
 readily feels noises is seen by the natural avoidance of 
 noise we all show when tired or when ill with a head- 
 ache. A concussion applied through the ear takes the 
 nerve by surprise, and, by displacing and wounding it, 
 causes deafness. 
 
 Inflammatioji of the Brain, — Many diseases destroy 
 the hearing by producing inflammation of the mem- 
 branes of the brain and a consequent disease of the 
 auditory nerve. Prominent among such causative dis- 
 eases is spotted fever (cerebro-spinal meningitis). As 
 the patient recovers from the disease he is found to be 
 entirely deaf in one or both ears. The same result is 
 also seen after brain fever, scarlet fever, convulsions, 
 and small-pox, especially in little children. 
 
 Spotted fever has caused many cases of absolute deaf- 
 ness in children, who in consequence have become deaf 
 and dumb. 
 
 Disease of the internal ear is sometimes found in 
 children suffering from '^ rickets.^^ This affection alters 
 the bone in which the auditory nerve lies, in the internal 
 ear, and, pressing open the nerve, destroys its functions. 
 
 The semicircular canals in some instances are the 
 seat of primary disease. This may be inflammatory 
 or apoplectic. After exposure to great heat, especially 
 of the sun, an inflammation may start up in the in- 
 ternal ear and destroy the auditory nerve. Also after 
 great fatigue and mental strain, great congestion or the 
 rupture of a blood-vessel may occur in the internal ear. 
 As this occurrence takes place in a very confined space 
 within unyielding bony walls, the pressure thus exerted 
 on the nerve is sudden and intense. Immediately the 
 
136 DISEASES AND INJURIES OF THE EAR, 
 
 hearing is greatly impaired, and the pressure of the 
 blood on the auditory nerve induces a destructive in- 
 flammation in it, resulting in permanent deafness. 
 There is usually associated with such an event as just 
 described great dizziness and nausea, and the patient 
 has aural vertigo from disease in the semicircular canal 
 of the internal ear. 
 
 Aural Vertigo. — Dizziness and vertigo may be caused 
 by irritation and disease in the external or the middle 
 ear (p. 100). Some of the worst cases of ear-vertigo 
 are produced by a disease in the internal ear, probably 
 in that part of it called the semicircular canals. Dis- 
 ease in these canals may have its origin in a chronic 
 disease in the middle ear, which, by weakening the 
 blood-vessels, at last affects the internal ear. Or the 
 disease may have its origin in a tumor in the brain, 
 which, gradually advancing through the auditory nerve, 
 at last invades the internal ear. 
 
 Unfortunately, all forms of ear-vertigo are confused 
 and confounded with one another; and in some in- 
 stances there is a commingling of different forms in the 
 same individual. Aural vertigo, especially when due 
 to disease of the internal ear, is often mistaken for 
 stomachic vertigo, the so-called biliousness, epilepsy, 
 and even apoplexy. However, the great guides in the 
 differential diagnosis between this disease and those 
 just named are the aural symptoms, ringing in the 
 ears and deafness, and the retained consciousness, which 
 are found in aural vertigo. 
 
 In aural vertigo we observe great pallor and no 
 spasm, while in a fit there are spasms and congestion 
 of the face. 
 
DISEASES AND INJURIES OF INTERNAL EAR. I37 
 
 In apoplexy there are loss of consciousness and red- 
 ness of the face, but no spasm. The form of aural 
 vertigo evoked by disease in the internal ear is best 
 known as Meniere's disease. In fact, this term should 
 not be applied to aural vertigo in general, as it often is, 
 but only to that form which is due to disease in the 
 internal ear and the semicircular canals. 
 
 That form of ear- vertigo which is due to the growth 
 of a tumor in the brain near or upon the auditory 
 nerve has the peculiarity of being constant. It is not 
 intense at first, but gradually becomes very great as 
 the tumor enlarges and the pressure in the nerve and 
 internal ear increases. It, like the form just described, 
 is attended with profound deafness. 
 
 The apparent motion in ear-vertigo from disease of 
 the semicircular canals of the internal ear is sometimes 
 in a vertical and sometimes in a horizontal plane, ac- 
 cording to the semicircular canal most affected, as it is 
 supposed. Two of these canals are in vertical planes, 
 while the third is horizontal. 
 
 Treatment, — Aural vertigo is dependent upon the 
 pressure upon the water in the internal ear, communi- 
 cated thence to the auditory nerve and the brain. This 
 form of giddiness can be cured only by removing the 
 diseased condition of the ear which causes the undue 
 pressure. In the case of vertigo from external or 
 middle ear disease this is easier than in the case of ear- 
 vertigo from disease in the internal ear. Vertigo 
 caused by a tumor in the brain and auditory nerve 
 cannot be cured. 
 
 If the vertigo is due to effusions of blood or other 
 matters into the internal ear, absorption of these fluids 
 
138 DISEASES AND INJURIES OF THE EAR. 
 
 will remove the vertigo. This end can be obtained by 
 giving the so-called alterative medicines, which pro- 
 mote absorption, if the pressure on the auditory nerve 
 is caused by effusion or hemorrhages into the bony 
 labyrinth, where the nerve lies. 
 
 If the pressure is due to a retraction of the drum- 
 membrane and the chain of little bones, held in this 
 position by adhesions between them and the inner wall 
 of the drum-cavity, this can be taken off by an opera- 
 tion, and the noises in the ear and the vertigo entirely 
 cured. In these cases the hearing is usually very bad, 
 and the operation, if it does not improve it, can make 
 it no worse. 
 
 The operation consists in a removal of the diseased 
 drum-membrane and the two largest and outermost 
 ossicles. Their removal permits the stirrup-bonelet to 
 recede from its iuipacted position in the oval window. 
 The inward pressure on the labyrinth-water and the 
 nerve of hearing is thus taken off, and the dizziness 
 and noises in the head are relieved. The patient who 
 undergoes this operation must first be etherized. The 
 illumination of the ear must then be effected by means 
 of a small electric lamp held on the head of the surgeon. 
 The lamp is run by the current from a small portable 
 storage-battery. 
 
 All sports which lead to congestion of the head, 
 like ^^ standing'^ on the head, and hanging with the 
 head down, should be discouraged. Also, for various 
 reasons, exposure to intense heat from the direct rays 
 of the sun, and from its reflection on hot and open 
 fields, should be avoided, especially near mid-day in 
 summer-time, as all of these influences tend to con- 
 
DISEASES AND INJURIES OF INTERNAL EAR, 139 
 
 gestion of the head and of the internal ear, especially 
 if there has been chronic disease in the middle ear. 
 Chronic catarrh of the middle ear has the effect of 
 predisposing the internal ear to congestion and injBaai- 
 mation, with consequent deafness of a profound degree. 
 It has-been already stated that many cases of deaf- 
 dumbness are traceable primarily to a catarrhal disease 
 in the middle ear, which finally leads to a disease in 
 the auditory nerve. 
 
 It is very apparent, then, that there is a great need 
 of care in the case of children, that they be kept from 
 influences likely to produce catarrhal disease in their 
 ears, as well as from those influences which may in- 
 duce concussion, congestion, and inflammation in the 
 internal ear. Infants should be carefully guarded 
 against blows and falls on the head, and children of 
 all ages should be instructed not to give nor receive in 
 rude play rough blows on the head and ears, nor to in- 
 dulge in gymnastics which include hanging with the 
 head downward for any length of time. If their rec- 
 reations or labors lead them into the intense heat of 
 the direct rays of the sun in summer-time, they should 
 be taught that their heads must be well protected with 
 a light but fairly thick hat. Some hats are so thin 
 that the sun shines quite through them; they are a 
 false security. 
 
 Exposure to great heat during the day and then to a 
 chilling at night, induced by sleeping in a cool draught 
 or on the cold and damp ground, will induce profound 
 congestion of the internal ear. This, in turn, may in- 
 duce the growth of a tumor in the auditory nerve, 
 which, by invading the brain, will prove fatal. 
 
140 DISEASES AND INJURIES OF THE EAR. 
 
 In typhoid fever^ a fatty degeneration of the auditory 
 nerve, in the labyrinth, may ensue, with profound and 
 incurable deafness. 
 
 In the insane, the ears may become the seat of dis- 
 tressing noises, due to prervious catarrhal disease in the 
 middle ear. These sounds in the ears lead to halluci- 
 nations of hearing in the insane mind, and make the 
 patient worse. Wherever hallucinations of hearing are 
 discovered in the insane, the ears should be examined, 
 and if disease of the external or middle ear is found 
 it should be made better or cured, if possible. 
 
 Effects of Quinine on the Auditory Nerve. — It is well 
 known that quinine congests the membrana tympani 
 and middle ear. It is also known by recent experi- 
 ments of Schilling, Biirkner, and others, in Germany, 
 made upon some lower animals, that large doses of 
 quinine, ten to twenty grains at a time, will so intensely 
 congest the nerve in the labyrinth of a cat as to de- 
 stroy it in a few hours. The same is true of large 
 doses of salicylic acid. 
 
 These experiments were performed by first adminis- 
 tering the dose of quinine and then killing the animal 
 very soon afterwards. Upon examining the internal 
 ear, the nerve of hearing was found injured as de- 
 scribed above. 
 
 What happens in the cat can happen, and doubtless 
 has happened, in the human being. Therefore large 
 doses of quinine are likely to destroy the hearing. 
 Smaller doses given at intervals will do more good, 
 and are not attended with the dangers to hearing above 
 mentioned. I would not willingly take ten grains of 
 quinine at a dose, and therefore I would not advise it, 
 
DISEASES AND INJURIES OF INTERNAL EAR. 141 
 
 but, on the contrary, I would strongly deprecate its 
 administration to any one. The same caution should 
 be observed in the administration of salicylic acid. 
 
 THE DEAF AND DUMB. 
 
 When a child is born deaf, or under six years of age 
 becomes profoundly deaf from any form of aural dis- 
 ease, it passes into that unfortunate group of our fellow- 
 creatures called the deaf and dumb. Let me say here 
 that comparatively few children are born deaf, that the 
 deaf and dumb have just as good vocal organs as 
 those who can hear, and that their minds are just as 
 good as the mind of the average child among those 
 who can talk. The dumb cannot talk because they 
 cannot hear, and hence have not learned by hearing 
 others talk. If the deafness occur before the child 
 has learned to talk, it is difficult to instruct it in any- 
 thing, especially in the idea of what the use of speech 
 is. If the child has learned to talk before the deaf- 
 ness has come upon it, it at least knows what speech is, 
 and what the effort at talking consists in. This knowl- 
 edge on its part is a great aid in keeping up its power 
 to talk and in perfecting its speech. Even the unfor- 
 tunate child in the first group can be made to under- 
 stand what is said to it, by watching the mouth and 
 lips of the speaker; but this is harder in his case than 
 in that of the child who has once talked. This topic 
 will be found further considered in the next chapter. 
 
F>ART III. 
 
 AURAL HYGIENE OF THE DEAF. 
 
 CHAPTER I. 
 
 AUEAL HYGIENE AND EDUCATION OF PARTIALLY 
 DEAF CHILDREN. 
 
 There is a large number of deaf children who can 
 hear and talk. They may have become profoundly 
 deaf in consequence of ear-disease brought on by scarlet 
 fever, measles, or smallpox. Some have called these 
 semi-mutes, and many of them are found in institutions 
 for the deaf and dumb. If they are placed in such 
 schools they will grow deafer, because their remaining 
 hearing gets no exercise, and by falling into disuse 
 grows worse or is lost entirely. Their speech meets 
 the same fate, for, as they are not called upon to use 
 it in the schools for the deaf and dumb, they forget 
 how to talk, and this valuable acquirement is lost, like 
 the remnant of their hearing, from disuse. 
 
 Such children should not be permitted to enter 
 schools for the deaf and dumb. They should be en- 
 couraged to go to school with hearing children, their 
 defect being known to the teacher, who must make 
 allowance for it by placing them near the teacher's 
 desk. This will force them to exercise both their hear- 
 142 
 
AURAL HYGIENE AND EDUCATION, ETC, 143 
 
 ing and their speech, and they will be kept from falling 
 into the comparatively helpless class, the deaf-mutes. 
 
 Parents and teachers must find out whether children 
 are deaf or not. Very often children are suspected of 
 being inattentive, and are punished accordingly, when 
 in reality they are deaf and do not catch half that is 
 said to them. When a child is in this position of 
 semi-disgrace, it is highly probable that it is due to 
 deafness ; and parents and teachers ought to know this. 
 It may be that its hearing can still be improved before 
 it is too late and the child becomes deafer. In any 
 case its condition of hearing should be determined by 
 careful examination or by tests. This latter a parent 
 or a teacher could do by placing the child at a short 
 distance away, with one ear stopped and the other 
 turned towards the examiner. Now let isolated words 
 be spoken and the child told to repeat what the teacher 
 or parent says, or what it thinks has been said. If it 
 does not hear single words of ordinary tone at a dis- 
 tance of ten feet, it is decidedly deaf. After one ear 
 is tested, let the other be tried in the same way. When 
 the distance is found out at which the child hears words 
 of ordinary tone, let its desk or seat be placed at that 
 distance from the teacher. It will generally be found 
 that a child thus deaf will begin to talk less or talk in- 
 distinctly or like a younger child, and perhaps to make 
 signs. This defect must be overcome by forcing it to 
 speak out, by correcting its mistakes in pronunciation, 
 and by totally ignoring its signs. It must get nothing 
 but what it asks for in words, not by signs. By such 
 natural means the hearing and speech are retained and 
 improved. 
 
144 DISEASES AND INJURIES OF THE EAR. 
 
 If a large number of such children could be brought 
 together, the entire plan of teaching might be adapted 
 to their wants, in the above way. As a rule, they will 
 be found scattered sparsely through the community, 
 and therefore must go to school with hearing children 
 or into schools for the deaf and dumb. If they are 
 found in the latter place and allowed to stay, they 
 ought to be taught in a way to improve their hearing 
 and their speech, and not in one which tends further 
 to impair these valuable functions. 
 
 Partially deaf children can be helped in retaining 
 their remnant of hearing and in improving it, and also 
 their power to speak, by the use of some good ear- 
 trumpet and by daily exercise in speaking, reading, and 
 singing. . This is best done by their parents or a careful 
 private instructor. 
 
 The Otophone, — One of the best means of conveying 
 sound to a deaf ear, and of conducting the education 
 of a deaf child as I have suggested, is the otophone of 
 J. A. Maloney, of Washington, D.C. This consists of 
 a flexible tube about three and one-half feet long and 
 an inch in diameter, with a mouth-piece of convenient 
 arrangement for the speaker. The aural end, for the 
 patient, does not fit into the meatus, like all other ear- 
 trumpets, but has the great advantage in comfort of 
 terminating in a disk, resembling the receiver of a 
 telephone, which is held over the ear. This avoids the 
 great discomfort at the outset so often complained of 
 by those forced to use an ear-trumpet of the old pattern, 
 which fits into the meatus of the auditory canal. By 
 an arrangement of soft-rubber membrane in this ear- 
 piece of the otophone, the disagreeable resonance so 
 
AURAL HYGIENE AND EDUCATION, ETC, 145 
 
 prominent in the entirely open instrument is prevented. 
 In addition to these two advantages, the otophone of 
 Maloney seems to convey sound to the deaf ear more 
 completely than any other instrument as yet offered to 
 the deaf. 
 
 With the careful use of this instrument fifteen min- 
 utes once, twice, or thrice a day, as the ear is able to 
 tolerate the exercise, the hearing can be improved, and 
 a deaf child instructed in the use of speech. A child 
 who is thus being taught should be made to repeat 
 words and sentences correctly after its teacher, if it 
 has shown any tendency to avoid the use of speech or 
 to speak words incorrectly or imperfectly for its age. 
 It will be found that a deaf child of five or six who 
 has become deaf, say, at the age of four, will continue 
 to talk like a child of four, or even retrograde to the 
 speech of a child of two or three years. This defect 
 can be corrected by speaking into its ear with the mouth 
 close to it; but few will have the patience thus to 
 correct or instruct the child. The systematic use of 
 words spoken through the otophone will overcome and 
 prevent this defective pronunciation of words. All 
 signs must be discouraged, and the use of properly- 
 spoken words encouraged. A deaf child must be cor- 
 rected in the improper pronunciation of a word at once, 
 and not disregarded in this particular as the child with 
 good hearing. The latter will be corrected in time 
 by hearing the proper pronunciation of words in his 
 teachers and playmates ; but not so with the deaf child : 
 he will continue indefinitely to say ^^otch" for " watch'^ 
 unless corrected at once. Baby-talk must not be per- 
 mitted in it 
 
 Q k 13 
 
146 DISEASES AND INJURIES OF THE EAR. 
 
 I have kDown deaf children prevented from be- 
 coming deaf-mutes by the careful attention and in- 
 struction of their mothers, carried on by speaking 
 close to the ear. The teachers must assure themselves 
 that the child hears what is said, by requiring a repe- 
 tition of it from the child. This requires patient labor; 
 but who would not do this rather than see their child 
 become a deaf-mute, deprived of the pleasures and ad- 
 vantages of speech and hearing ? Such labor is cer- 
 tainly lessened by the use of any form of ear-trumpet, 
 if the latter will convey the sound of the teacher's 
 voice to the deaf ear. In schools such form of teach- 
 ing becomes almost impracticable, because only one 
 child at a time can be thus instructed. An instru- 
 ment may be arranged with a number of tubes, con- 
 nected with one receiver for the teacher's voice. By 
 such means a class of deaf children could be instructed 
 in hearing and in speaking, and at the same time. 
 Such attentions to the deaf child cheer it, and prevent 
 the sad, half-suspicious retirement within itself which 
 is so frequently seen in this unfortunate class, and 
 which is due to the neglect they experience often 
 through the ignorance of their defective hearing on 
 the part of parents and teachers. The deaf and dumb 
 are just as intelligent as the average hearing children 
 of the ordinary schools. The mere fact of deafness is 
 not necessarily a sign of intellectual defect. If the 
 deafness is an attendant of a brain-disease, the latter 
 may have caused the child's mind to be weakened; 
 but the deafness has nothing to do with the intellectual 
 weakness. Brain-fever will injure the mind, even if 
 the child is not made deaf by it. 
 
AURAL EDUCATION OF DEAF-MUTES. 147 
 
 CHAPTER II. 
 
 AURAL HYGIENE AND EDUCATION OF THE DEAF 
 AND DUMB. 
 
 Either by neglect of the precautionary methods men- 
 tioned in the previous chapter, or from profound disease 
 in the ears^ children become absolutely deaf and conse- 
 quently dumb. All such children should receive a care- 
 ful examination of their ears and a test of their hearing 
 before they are pronounced to be deaf-mutes and con- 
 signed to schools for the deaf and dumb. Sometimes it 
 will be found, in the youngest of such cases, that there 
 is an ear-disease, like a chronic running from the ear 
 or ears or a catarrh of the nose and middle ears. By 
 curing these, or relieving them, the hearing may be im- 
 proved sufficiently to permit the use of an ear-trumpet 
 in its instruction. When an ear is the seat of a chronic 
 discharge, in a deaf child, it is often neglected because 
 it is supposed that the child is hopelessly deaf and a 
 cure of the discharge will not relieve the deafness. 
 This is an erroneous conclusion to come to, because a 
 cure of the discharge may improve the hearing, and it 
 certainly will remove the bad odor, attendant upon this 
 disease, from the child, and render it more agreeable for 
 teachers and companions to approach. 
 
 This latter is a most important consideration for 
 parents and teachers to entertain. It is due to the 
 child to render it as agreeable as possible in a cosmetic 
 sense, in order that to its other social disabilities there 
 
148 DISEASES AND INJURIES OF THE EAR. 
 
 should not be added a constant bad smell from its ears 
 or head. 
 
 Lip-reading and Articulation. — The social condition 
 of deaf-mutes is greatly improved by teaching them lip- 
 reading and articulation. This is best accomplished by 
 beginning when the child is six years old. It is not 
 well to begin much before nor after this age. It con- 
 sists in teaching the child to know what is said to it by 
 the motions and position of the lips of the speaker. 
 These motions and positions the child is taught to imi- 
 tate, and the vocal sounds, necessary for articulation, 
 are taught it by placing its hand on the larynx of the 
 speaker and perceiving by the vibrations how to use its 
 own larynx with the proper movements. When master 
 of lip-reading and articulation, the deaf-mute may pass, 
 in the world at large, for a hearing person. It requires 
 several years for the deaf-mute to acquire this accom- 
 plishment. Children who have once heard and learned 
 to talk some, but have lost their hearing and then their 
 speech, are the easiest to teach lip-reading and articula- 
 tion, as they have an excellent idea how to use their 
 vocal organs. It is very difficult to convey this idea 
 to the child who has never heard and hence has never 
 spoken. It is astonishing to find how much hearing is 
 still retained by the very deaf-mute. This has been 
 termed latent hearing by some. I am convinced that if 
 the young mute were carefully tested, especially one of 
 that class who have become deaf by disease in early 
 childhood, it would often be found possessed of more 
 hearing than was supposed. Here again great effort and 
 patience would be required to develop the hearing if 
 any were found still present. A good ear-trumpet, 
 
AURAL EDUCATION OF DEAF-MUTES. I49 
 
 such as I have described, would be the greatest aid in 
 all such endeavors (p. 144). 
 
 A mute child often hears more than one supposes, 
 although it cannot reproduce either by writing or by- 
 words what it hears spoken to it through an ear- 
 trumpet. As the child has never used its ears nor 
 learned to speak by hearing in the ordinary way, it is 
 nearly as unable to understand and repeat words spoken 
 to it through an ear-trumpet as a hearing child would 
 be to understand and repeat a word in a foreign lan- 
 guage heard for the first time. 
 
 Teachers should not be discouraged, therefore, in 
 their first endeavor to find latent hearing in mutes, 
 and to develop it by means of an ear-trumpet or an 
 otophone. 
 
 13* 
 
INDEX. 
 
 Alcoholic drinks, effects of, on the 
 
 ear, 71, 98. 
 Anvil, or incus, 15. 
 Articulation of deaf and dumb, 
 
 147. 
 Aspergillus, 51, 60. 
 Auditory bones, 14. 
 Auditory canal, 10. 
 
 aspergillus in, 51, 60. 
 
 boils, 49. 
 
 bone tumors, 56. 
 
 cancer, 57. 
 
 diseases, 42. 
 
 eczema of, 49. 
 
 function, 27. 
 
 fungus in, 51. 
 
 hemorrhage from, 55. 
 
 shingles, or herpes zoster, in, 
 52. 
 
 syphilitic eruptions, 52. 
 Aural catarrh, causes, 108. 
 Auricle, diseases of, 35. 
 
 eczema of, 39. 
 
 frost-bites, 35, 36. 
 
 function, 26. 
 
 pulling, 41. 
 
 skin-diseases of, 38-40. 
 
 sunburn, 39. 
 Aurilave, 59. 
 
 Bathing, chronic catarrh, 117, 118. 
 Bleeding from the ear, 55. 
 Blowing the nose, effect of, on the 
 
 ear, 123. 
 Blows and falls, effects of, 133. 
 
 Boils in auditory canal, 49. 
 
 Bone tumors in the ear, canal of, 
 
 56. 
 Boric acid in the ear, 81, 
 "Boxing the ear," 68, 133. 
 Brain^ inflammation of the, 93, 
 
 135. 
 Bromide potash, in colds, 122. 
 Bubbles of air in drum, 105. 
 Bursting the drum, 68, 
 
 Canal, auditory, 10. 
 
 Cancer in the ear, 57. 
 
 Catarrh, chronic, of ears, 94-104. 
 
 malodorous, 125, 126. 
 
 remedies, 83. 
 Catheter, Eustachian, 127. 
 Changes of temperature, 115, 120. 
 Chronic catarrh of middle ear, 94- 
 104. 
 
 causes, 108. 
 
 condition of nose in, 104. 
 
 condition of throat, 104. 
 
 effect of dyspepsia, 121. 
 
 hygiene of the ear. 111. 
 
 tobacco, effects of, in, 122. 
 
 treatment, 123-133. 
 Chronic discharge from the ear, 86. 
 
 treatment, 87-89. 
 Cleft lobule, 38. 
 
 Clothing in ear-diseases, 118, 119, 
 Cochlea, 21. 
 Cold in the head, 122, 123. 
 
 bathing, effect of, on the ear, 
 65. 
 
 151 
 
152 
 
 INDEX. 
 
 Corti's organ, 22, 23. 
 Cotton in the ear, 69. 
 
 bad effects of, 69, 80, 81. 
 Cracking sounds in the ears, 105. 
 
 Deaf and dumb, 141. 
 
 education of, 147-149. 
 Deaf children, education of 142- 
 
 147. 
 Deafness, cure of, by operation, 
 
 131. 
 Dental fillings, effect of, on the ear, 
 . 54. 
 Dental plates, effect of, on the ear, 
 
 54. 
 Disease caused by running ear, 
 
 86. 
 Diseases of auditory canal, 42. 
 Diving, effects of, on the ear, 84, 
 
 109. 
 Divisions of ear, 7. 
 Dizziness, 100. 
 Douche for nose, 83. 
 Drum, acute inflammation of, 73. 
 boundaries of, 17. 
 cavity, 14. 
 membrane, 10, 11. 
 perforation of, 69. 
 rupture of, by disease, 68. 
 by surf, 65. 
 Dry heat, effects of, on the ear, 
 
 79. 
 Dyspepsia, effect of, on the ear, 
 121. 
 
 Earache, 73, 74. 
 
 from diseased teeth, 53, 54, 82. 
 
 treatment of, 74-77. 
 Ear-canal, neuralgia of, 53. 
 Ear, discharge from the, 86. 
 
 eczema of the, 39. 
 
 effects of cold-water bathing 
 on the, 65, 66. 
 
 Ear, effects of swimming on the, 84. 
 
 hard skin in the, 60. 
 
 injured by explosions, 69, 70. 
 
 itching in the, 63. 
 
 protection of the, 64. 
 Ear-picks, 59. 
 Ear-rings, 37. 
 Ear-spoon, 59. 
 Ear-swabs, 59. 
 Ear-vertigo, 96. 
 Ear-wax, hardened, 59. 
 
 removal of, 58. 
 Eczema of auditory canal, 49. 
 
 of ear, 39. 
 Electricity in ear-disease, 131. 
 Eustachian catheter, 127. 
 
 tube, 19, 30. 
 
 in chronic aural catarrh, 
 106, 107. 
 Exercise in chronic catarrh, 114, 
 
 115. 
 Explosions, effects of, on drum, 70. 
 External ear, 9. 
 
 diseases and injuries of, 35. 
 
 Folds in drum, 13. 
 
 Eood and drink, chronic catarrh, 
 
 120. 
 Foreign bodies in the ear, 42. 
 
 removal of, 43-45. 
 Frost-bites of auricle, 35, 36. 
 Fungus in the ear, 51, 
 
 Gargles, 128, 129. 
 
 Glycerin, use of, in the ear, 62. 
 
 Hair-cutting, effect of, on the ear, 
 
 85. 
 Hair-washing, effect of, on the ear, 
 
 84. 
 Hammer, 11. 
 Hard skin in the ear, 60. 
 removal of, 60. 
 
INDEX. 
 
 153 
 
 Hearing, 25. 
 
 in a noise, 101. 
 Heat, effect of, on the ear, 139. 
 Hemorrhage from auditory canal, 
 
 55. 
 Herpes zoster (shingles) of the ear, 
 
 52, 53. 
 Hole in the drum, 130, 131. 
 Hunting, effects of, on the ear, 109. 
 Hygiene of auricle, 39. 
 
 in chronic catarrh, 111, 
 of external ear, 58. 
 
 Incus, or anvil, 15. 
 Inflation of the ears, 126. 
 Insanity, ears in, 139. 
 Insects in the ear, 46. 
 Intensity of sound, 24. 
 Internal ear, 20-23, 32. 
 
 diseases and injuries of, 132- 
 141. 
 Itching in the ear, 63. 
 
 Labyrinth, 21-23. 
 Lancing the drum, 80. 
 Latent hearing, 148, 149. 
 Laudanum and sweet oil, 77. 
 Leeching, effects of, on the ear, 80. 
 Lip-reading, 147. 
 Lobule, development of, 38. 
 torn, 38. 
 
 Malleus, 11. 
 Mastoid cells, 20, 31. 
 
 disease, 91. 
 
 operation in, 93. 
 treatment of, 92. 
 Matter from the ear, 80, 81. 
 Medicines, effect of, on the ear, 121. 
 Membrana flaccida, 13. 
 Membrana tympani, 10, 11. 
 
 bubbles behind, 107, 108. 
 
 diseases of, 67. 
 
 Membrana tympani, function, 28. 
 
 in chronic and aural catarrh, 
 107. 
 Membrana vibrans, 13. 
 Meniere's disease, 96, 137. 
 Middle ear, diseases of, 72. 
 
 inflammation of, causes of, 82. 
 
 injuries of, 72. 
 Mouth-breathing, 97, 105, 115. 
 
 Nasal douche, 83. 
 
 syringe, 83. 
 Neuralgia of ear-canal, 53. 
 Noises, effect of, on the ear, 134. 
 
 hearing in, 101. 
 
 in the head, cure of, 131. 
 Nose-disease, effect of, on the ear, 
 
 73. 
 Nose in chronic aural catarrh, 104. 
 
 in ear-disease, 94. 
 
 treatment, 124. 
 
 Ossicles of hearing, 14-17. 
 Otophone, 144. 
 
 Overeating, effects of, on the ear, 
 76. 
 
 Palate down, 128. 
 
 in chronic aural catarrh, 106. 
 Perforation of drum, 69. 
 Physiology of the ear, 24-34. 
 Pick for the ear, 59. 
 Pitch (sound), 24. 
 Polypus in the ear, 89, 90. 
 
 treatment, 90, 91. 
 Poultices, effects of, on the ear, 77, 
 
 78. 
 Protection of ear, 64. 
 Pulling auricle, 41. 
 Purulent disease of ear, 86. 
 Pyramid of light, 12. 
 
 Quality of sound, 24. 
 
154 
 
 INDEX, 
 
 Quinine, eflfects of, 75, 121, 122, 
 140. 
 
 Rickets, effect of, on the ear, 135. 
 Running from the ear, 86. 
 Rupture of drum, treatment of, 
 70, 71. 
 
 Salicylic acid, effect of, on the ear, 
 
 121. 
 Sea-bathing, effect of, on the ear, 
 
 ^^. 
 Sea-shore, cold in the ear at the, 67. 
 Semicircular canals, 21, 33. 
 Sensation of hair in the throat, 
 
 106. 
 Shampoo, effect of, on the ear, 85. 
 Shingles of ear, 52. 
 Singing in chronic catarrh, 107. 
 Skin, collection of, in the ear, 60. 
 Skin-diseases, eflfects of. on the ear, 
 
 132. 
 Skull, fracture of, effect of, on the 
 
 ear, 133. 
 Slippers, in chronic catarrh of the 
 
 ear, 116. 
 Sneezing, effect of, on the ear, 123. 
 Snuff, effect of, on the ear, 122. 
 Sound, 24. 
 
 Spoon for the ear, 59. 
 Spotted fever, 135. 
 Sprays for the nose, 124. 
 Stapes, or stirrup, 16. 
 Sun, exposure to, 115, 
 Sunburn of the ear, 39. 
 Surf, effects of, on the drum, 65. 
 Swab for the ear, 59. 
 Sweet oil in the ear, 61. 
 Swimming, effect of, on the ear, 84. 
 Syphilitic eruptions on the ear, 52. 
 Syringing the ear, 47. 
 
 Teeth, effect of, on the ear, 53, 54. 
 
 Telegraph and telephone, eflfects of, 
 
 on the ear, 110. 
 Temperature, changes in, 115, 
 Thickened drum, 94. 
 Throat in ear-disease, 94. 
 Tobacco, eflfects of, on the ear, 71, 
 
 98, 122. 
 Tobacco-chewing, eflfects of, on the 
 
 ear, 98. 
 Tonsils, 127, 128. 
 
 Toothache, treatment of, by ear, 62. 
 Treatment of diseases of auricle, 
 48. 
 
 boils in ear, 49. 
 
 chronic catarrh, 123-133. 
 
 cold in the head, 122, 123. 
 
 deafness, 131. 
 
 earache, 74-77. 
 
 electricity, 131. 
 
 frost-bites, 35, 36. 
 
 fungus, 51. 
 
 mastoid, 91. 
 
 membrana tympani, 80. 
 
 Meniere's disease, 137. 
 
 noises in the head, 131. 
 
 nose, 124. 
 
 polypus, 90, 91. 
 
 running from the ear, 87-89. 
 Tumor in brain, 132. 
 Tympanic cavity, 30. 
 Typhoid fever, eflfects of, 132. 
 
 Uvula in chronic catarrh, 106. 
 elongation of, 128. 
 
 Ventilation in chronic catarrh, 113, 
 
 114. 
 Vertigo, 96, 100, 136. 
 
 cure of, 138. 
 Vestibule, 33. 
 
 Washing hair, effect of, on the ear, 
 84. 
 
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