/ 
 
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TREATISE 
 
 ON THE 
 
 iat)))stolog)> anB diseases 
 
 OF 
 
 THE EAR; 
 
 CONTAINING 
 
 A COMPARATIVE VIEW OF ITS STRUCTURE 
 AND FUNCTIONS, 
 
 AND OF ITS 
 
 VARIOUS DISEASES, 
 
 ARRANGED ACCORDING TO THE 
 
 ANATOMY OF THE ORGAN, OR AS THEY AFFECT THE 
 EXTERNAL, THE INTERMEDIATE, AND THE 
 INTERNAL EAR. 
 
 SECOND EDITION , 
 
 WITH CONSIDERABLE ADDITIONS AND IMPROVEMENTS. 
 
 BY 
 
 JOHN HARRISON CURTIS, Esq. 
 
 Aurist to His Royal Highness the Prince Regent, His Royal Highness the 
 Duke of Kent, their Royal Highnesses the Duke and Duchess of 
 Gloucester, Surgeon to the Royal Dispensary for Diseases 
 of the Ear, Lecturer on the Anatomy, Physiology, and 
 Pathology of the Ear, Fellow of the Medical 
 Society of London, &c. &c. 
 
 LONDON : 
 
 PRINTED FOR JOHN ANDERSON, 
 
 40 , WEST 3MITHFIELD. 
 
 ' 7 
 
 AND SOLD BY CALLOW, PRINCES-STREET, SOHO ; COX AND SON, ST. THOMAS’S 
 STREET; HIGHLEY AND SON, T. AND G. UNDERWOOD, FLEET-STREET; 
 BURGESS AND HILL, GREAT WINDMILL STREET ; FF, ARMAN, NEW 
 BOND STREET ; A. BLACK, EDINBURGH; AND HODGES AND 
 *f ARTHUR, DUBLIN. 
 
 1819 , 
 
Q^Ui vt.\S 
 
 
 
 
 
 
 
 ■ 
 
 
 
 
 
 - 
 
 
 
 
 
 
 
 
 
 
 
 ~ 
 
 
 
 
 
TO HIS 
 
 ROYAL HIGHNESS 
 
 THE PRINCE REGENT, 
 
 IN TOKEN OF THE 
 
 AUTHOR’S GRATEFUL SENSE 
 
 OF HIS 
 
 ROYAL HIGHNESS’S GRACIOUS CONDESCENSION, 
 
 IN BECOMING THE PATRON OF THE 
 
 fox fyt of 
 
 THE EAR, 
 
 AND IN 
 
 APPOINTING HIM 
 
 AURIST TO HIS ROYAL PERSON, 
 
 A SECOND AND IMPROVED EDITION OF 
 
 THIS WORK 
 
 Is most respectfully dedicated, by 
 His Royal Highness’s 
 Most obedient and most 
 Devoted Servant, 
 
 Joh?i Harrison Curtis. 
 
 Soho Square, 
 
 March 10th, 181 9. 
 
Digitized by the Internet Archive 
 in 2016 
 
 https://archive.org/details/treatiseonphysio01curt 
 
EXPLANATION OF THE PLATE. 
 
 a. Hearing Trumpet. 
 
 b. French Artificial Ear, with gold tube ; 
 
 internal side. 
 
 c. French Artificial Ear, with gold tube ; 
 
 external side. 
 
 d. The Tubes. 
 
 e. Spanish Ears. 
 
 /. Internal part of the German Silver Ear. 
 
 g. External part of the German Silver Ear. 
 
 h. Trumpet Case. 
 
INTRODUCTION 
 
 The improvements in Medicine and Surgery 
 of late years have been great and important, 
 but more particularly in the latter. In pro- 
 portion as civilization advances in every State, 
 the number of diseases is augmented, and the 
 profession acquires greater respect and estima- 
 tion from its more extensive utility. 
 
 In former times, Surgery, the most ancient 
 branch (for external accidents in savage life, 
 always precede internal disease) was simple, 
 and of limited extent. As improvement took 
 place, this department became gradually en- 
 larged ; and in point of science and principle, 
 
 B 
 
X 
 
 as it is now cultivated, it stands on a firmer 
 basis than Medicine. For the benefit of so- 
 ciety, it has been subdivided, by its professors, 
 into various departments, which, by calling for 
 a more minute attention to particular subjects, 
 has enlarged our views of them, and made us 
 more capable of affording effectual relief, under 
 circumstances formerly considered as beyond 
 the reach of the Healing Art. 
 
 One circumstance that retarded the progress 
 of surgery for some time, was the cultivation of 
 anatomy by the early physicians ; as witness, 
 the great and invaluable discovery of the 
 immortal Harvey, in the circulation of the 
 blood, which entirely changed the system of 
 medicine at that time ; the discoveries also 
 of Glisson and others of the earlier physi- 
 cians tended to promote this end. The physi- 
 cians presided at that period in the dissecting 
 room, and of course took a lead in whatever 
 regarded surgery, as well as medicine ; but the 
 
XI 
 
 increase of clinical practice to the physician, 
 induced him, in time, to lay aside his attention 
 to the dissecting room. As soon as that took 
 place, it naturally fell into the hands of the 
 surgeon, to whom it was at last solely consigned. 
 The moment the surgeon acquired this pre- 
 eminence, by the field of anatomy being left to 
 himself ; that moment, what was hitherto re- 
 garded as little better than a manual art, ex- 
 panded in its turn into an extensive branch of 
 science, and admitted divisions equally nume- 
 rous and varied, as those which had hitherto 
 been confined to the department of medicine. 
 
 The consequence of this has been that sur- 
 geons, anxious to improve that part of the 
 profession assigned them, have, many of 
 them of late years, limited their practice to 
 certain portions, or to the diseases of particular 
 organs, a circumstance which has been of the 
 highest utility to the interests of the community. 
 
 Though, on this point, surgeons have chosen to 
 
 b 2 
 
Xll 
 
 be divided in opinion, it is more, perhaps, from 
 self-interest, than from doubt of its utility ; for 
 every division clearly simplifies, and where a 
 subject is extensive and complex, simplicity and 
 perfection on any one point can never be ob- 
 tained in any other way. 
 
 This minute division of surgery, first began 
 with the diseases of the teeth, which certain in- 
 dividuals exclusively treated under the name of 
 Dentists, and who form now a numerous and re- 
 spectable body of practitioners. 
 
 It was next followed by others, in a similar 
 exclusive attention to the diseases of the eye, 
 under the name of Oculists, an organ which, from 
 its nice structure and the delicacy and minute- 
 ness of its parts, requires both a skilful hand for 
 the treatment of its diseases, and also an accurate 
 and profound know ledge of its anatomy. 
 
 The perfection these branches have acquired, 
 
xm 
 
 is tiie best proof how appropriately this division 
 has been made, from which the greatest public 
 benefit has accrued: for the advantage which 
 has resulted to mankind from the exercise of the 
 Oculist’s profession, as a distinct branch, is in- 
 calculable ; the operations on that delicate 
 organ, the eye, are now conducted with a nicety 
 and success unknown in former times : the for- 
 mation of an artificial pupil, as first invented by 
 Mr. Gibson of Manchester, and subsequently 
 improved by the late Mr. Saunders, and others, 
 has saved the sight of numbers, on whom former 
 operations had failed, and who, without this 
 discovery, must have continued in total darkness 
 for life. 
 
 The same happy result to society has been the 
 consequence of the profession of the Dentist. 
 The teeth are essential to the appearance and 
 symmetry of the visage ; without them that con- 
 tour and harmony of features, which the face 
 ought to possess, is wanting ; but the teeth are 
 
XIV 
 
 parts of the body which nature has intended 
 should more quickly decay than the other parts, 
 from their greater exposure to external causes, 
 acting upon, and destroying their enamel, and 
 osseous structure. When lost to the constitution, 
 not only is the beauty of the countenance im- 
 paired, but the process of digestion becomes im- 
 perfectly carried on, the food is no longer com- 
 minuted as it ought to be, and stomach com- 
 plaints, w ith a decay of general health, axe too 
 often the consequence. 
 
 The hand of the artist has here been the as- 
 sistant of nature ; the artificial substitutes are 
 equal in their effect to the real organized pro- 
 ductions originally implanted ; nay, to such 
 perfection has the art of man been carried, that 
 in cases of certain complaints, where the palate 
 or bony arch of the mouth has been destroyed, 
 and the unhappy sufferer has been incapable of 
 uttering and articulating, so nicely has mecha- 
 nism supplied the defect, that no trace of it can 
 
XV 
 
 be perceived, either in the articulation, or in the 
 reception of food. 
 
 These facts demonstrate clearly the advantage 
 of subdividing the objects of professional pursuit 
 or study, and bending a close attention to one 
 point ; it is applying to medical science, that 
 which experience has proved to be so successful 
 in the mechanical arts.* 
 
 If we take, for example, the construction of a 
 watch, there are no less than twelve different 
 and distinct departments in its manufacture, and 
 it is only by each department having but one 
 wheel or other appendage to do, that this useful 
 article is brought to its great exactness, perfec- 
 
 * This plan of subdividing its subjects has been long acted upon, also, in 
 another liberal and scientific profession, the Law, with much advantage. 
 The Counsellor who stands on the same footing as the Physician, often limits 
 his practice to particular Courts. The inferior departments are extensively 
 branched out into numerous divisions, to give clearness, perfection, and dis- 
 patch to the various and complex subjects, of which Law, as a branch of 
 science, consists. 
 
XVI 
 
 tion, and cheapness. The same plan is extended 
 to all the leading branches of manufacture in 
 this country, of which our manufacturing towns 
 afford the most striking examples ; and it is a 
 system, the utility of which has been strongly 
 enforced and reasoned upon by the late cele- 
 brated Dr. Adam Smith, in his “ Wealth of 
 Nations .’ 5 Indeed this subdivision and minute 
 attention to one branch may be considered as 
 the great safeguard of the manufactures of this 
 country ; perfection and cheapness are united by 
 it in a most eminent degree, which will stand 
 against the rivalship of any other nation, till the 
 same extent of population is employed as in this 
 country, and of course the same perseverance to 
 one object ; this is a fact which no reason can 
 refute, and the principle of it is interwoven with 
 our very nature. 
 
 The mind of man, it is clear, though capacious 
 and possessed of very extensive powers, cannot 
 embrace the whole circle of science, or retain it 
 
XVII 
 
 with that exactness which is necessary to excel ; 
 he must select a part of the circle, if he wishes 
 to shine, and must bend his attention to that 
 subject alone, in scientific pursuits.* However, 
 1 do not intend, by this observation, to convey 
 an idea, that the student should endeavour to 
 get acquainted with the department he selects, 
 only as a mechanical art, or that he should not 
 travel beyond its bounds : on the contrary, a 
 professional education should be so conducted, 
 as to make every one first acquainted with the 
 general principles and scope of every part of 
 the profession ; and this being once attained, 
 and the general studies completed, then , and 
 not till then , he should limit his pursuit to one 
 subject ; this subject, in consequence of his 
 previous acquirements, he will then better un- 
 
 * Such was the opinion of a celebrated relative of the author, the late 
 Mr. William Curtis, who, satisfied that no man can attend to two great 
 objects at once, with equal success and improvement, gave up his medical 
 pursuits for the study of Botany, in which he so eminently excelled ; stand- 
 ing in so near a connexion to the author as uncle, he took an early interest 
 in him, which he feels a particular satisfaction in thus acknowledging. 
 
 C 
 
 \ 
 
xvm 
 
 derstand ; he will be able to improve it by a 
 comparison and illustration of it with the other 
 branches he has studied, and make them all 
 bear on this favourite or leading topic : his 
 previous acquirements may be thus considered 
 in the light of scattered rays, which w ill be all 
 brought home to this central point or focus. 
 
 The person who is wedded to one subject, 
 acquires an intuitive knowledge from observa- 
 tion which cannot be conveyed by signs or even 
 explained by words. It is like the amateur, 
 who hearing a celebrated performer play on the 
 violin, wished to make a purchase of his instru- 
 ment ; on purchasing it, however, he could not 
 give it the same tones as its master ; and w hen 
 complaining to the latter of his cheating him, 
 he archly replied, “Ah, you forgot, you should 
 have purchased my lingers too.” 
 
 In estimating the different senses, how im- 
 portant is the sense of hearing, toman; it is 
 
XIX 
 
 the grand medium which connects him with 
 society, and that extends information and in- 
 telligence far beyond what the ej^e, or any of 
 the other senses can do. Through this medium 
 he is enabled to conduct the great and com- 
 plicated business of life. By it his harangue is 
 heard in the senate, and his commands in the 
 held. It forms the mutual and unembarrassed 
 communication of all sentiment and expression. 
 
 The organ of voice, the most pre-eminent 
 distinction of man, is even useless, unless its 
 powers are excited through the agency of this 
 sense ; and where hearing is defective in early 
 life, dumbness is generally the consequence. 
 
 A remarkable instance of the leading influ- 
 ence of this sense is recorded in the French 
 Memoirs, and quoted by the Count de BufFon ; 
 where the want of hearing seemed even to pre- 
 vent the very developement of the mind. 
 
 c 2 
 
XX 
 
 “ A young man of die town of Chartes, about 
 twenty-four, who had been deaf from his birth, 
 began all at once to speak, to the astonishment 
 of all who knew him. 
 
 “ He informed his friends, that for three or 
 four months before, he had heard the sound of 
 bells ; and that he was extremely surprised at 
 this new and unknown sensation. 
 
 “ Some time after, a kind of humour issued 
 from his left ear, and then he heard distinctly 
 with both. During these three or four months, 
 he listened to every thing ; and without at- 
 tempting to speak aloud, he accustomed himself 
 to utter softly the words spoken by others. He 
 laboured hard in acquiring the pronunciation 
 of w ords, and in learning the ideas annexed to 
 them. At length, thinking himself qualified to 
 break silence, he declared he could speak, 
 though still imperfectly. Soon after he was in- 
 terrogated by some able divines, concerning 
 
XXI 
 
 his former condition. The principal questions 
 turned upon God, the soul, and moral good 
 and evil ; but of these subjects he seemed to 
 have not the smallest conception. Though he 
 was born of Catholic parents, attended mass, 
 was instructed to make the sign of the cross, 
 and to assume all the external marks of devo- 
 tion, he comprehended nothing of their real in- 
 tention. He had formed no distinct idea of 
 death, and existed purely in an animal state : 
 wholly occupied with sensible objects, and with 
 the few ideas he had acquired by the eye, he 
 drew no conclusions from them. He did not 
 want parts ; but the understanding of a man, 
 when deprived of the intercourse of society, has 
 so little exercise or cultivation, that he never 
 thinks but when sensible objects obtrude them- 
 selves on his mind. The great source of human 
 ideas arises from the reciprocal intercourse of 
 society.” — Page 283, vol, 3. 
 
 Thus the defect of hearing appears to have 
 
XXII 
 
 locked up, as it were, tlie mental and rational 
 powers ; a strong proof of the necessity of the 
 intercourse of society, to give the mind its in- 
 formation and proper feeling, and to rouse its 
 different energies. The same thing is confirmed 
 by the account given of a savage boy found in 
 the woods of Ardennes, in France, who for 
 want of this social intercourse, which can only 
 take place through the influence of hearing, 
 possessed neither the powers of language, nor 
 any other feelings or ideas beyond those of 
 other animals.* An account of this case was 
 
 * So successful has the author been in his practice, that he was induced to 
 address the following letter to the Committee of Governors of the Asylum for 
 the Deaf and Dumb, w hich received their thanks on the occasion. His object 
 was that in addition to the consulting surgeon at present appointed to that 
 establishment, there should be an attending surgeon or aurist, who should 
 minutely examine every child offered for presentation, prior to their being 
 admitted into the asylum, and report his opinion to the committee how far 
 curable or otherw ise. 
 
 Soho Square, Jan. 11, 1817. 
 
 Gentlemen, 
 
 Tn presuming to address you on a subject which so materially interests the 
 institution for the Deaf and Dumb, your patronage of which does you so much 
 credit, 1 beg leave to premise, that my object is not to interfere in the least 
 with the present medical establishment ; as I have the highest opinion of the 
 
xxm 
 
 published some years ago, by Dr. Reid, of the 
 Royal College of Physicians. 
 
 In estimating the value of the different senses, 
 the best criterion to go by, is the opinion of 
 
 professional talents, and deserved reputation of the medical officers you have 
 been pleased to nominate : but these Gentlemen, I have no doubt, are too 
 liberal in their sentiments, not to admit that the defect of being deaf and 
 dumb, calls for an exclusive attention to these particular organs, greater than 
 can be paid by any practitioner in general practice, however distinguished 
 his abilities, or extensive his science, from wanting that particular experience 
 which one exclusively confining himself to this department of surgery must 
 possess. 
 
 In consequence of this, I beg leave most respectfully to suggest to your 
 consideration, the advantage that would result to the Institution, were an 
 aurist appointed to attend, and minutely examine the particular defect in 
 each child admitted into your establishment; by this means an opportunity 
 would be given of trying such methods as appear best calculated to give 
 relief ; and by this plan I conceive many of the objects of your laudable 
 charity might probably be found curable, restored to society, and rendered 
 useful; by which the bounds of your humane establishment would be extended, 
 and greater scope given to your highly benevolent views. 
 
 I have the honour to be, Gentlemen, 
 
 With great respect, 
 
 Your most obedient humble servant, 
 
 John Harrison Curtis. 
 
 To the Chairman and Committee 
 for the Deaf and Dumb. 
 
XXIV 
 
 such persons who have been partially deprived 
 of them. 
 
 A blind man, who has been for years in that 
 state, when desired to make a choice whether 
 he would prefer the restoration of sight, on 
 condition of the loss of hearing, has been heard 
 to say, that he considered himself happy, though 
 blind, while he was able to converse with his 
 friends. 
 
 Though this is in general . the case, it is 
 amazing, in some instances of early blindness, 
 to what perfection hearing has arrived, with a 
 view to supply the deficiency of the other 
 sense. 
 
 The situation of the ear is more internal, and 
 its powers more concentrated than those of the 
 eye ; its nervous expansion is more limited, and 
 the bodies which act upon it are denser, and 
 more solid than those of light ; hence the sensa- 
 
XXV 
 
 tions conveyed by it are limited, though more 
 durable than those of the eye. 
 
 If experience and improved knowledge have 
 shewn how much can be done to rectify the 
 imperfections and diseases of the eye — the same 
 experience, and the same ardent desire of im- 
 provement cannot fail to be equally successful 
 in those of the ear. 
 
 But the ear, though the most important of all 
 the senses, has hitherto claimed but little atten- 
 tion from the profession. The diseases of every 
 other organ are well understood, together with 
 the modes of repairing their defects ; but the 
 imperfections of this sense having been little 
 attended to by the regular profession, the treat- 
 ment has been, for the most part, confined to 
 the hands of empirics ; hence, obscurity and 
 prejudice have prevailed in this branch of prac- 
 tice, and an apathy has taken place on the 
 
 D 
 
XXVI 
 
 subject, highly injurious to the interests of 
 society. 
 
 It has been unfortunately laid down as a 
 maxim, that the diseases of this organ are incu- 
 rable. But this opinion has no just foundation ; 
 and, in fact, might have been applied with equal 
 propriety to the other organs, on which we daily 
 see such admirable cures performed. Indeed, 
 there can be no doubt, but experience, joined 
 with an ardent desire to improve, will be at- 
 tended with the same success in this as in every 
 other branch of medical science. 
 
 But to such a length has prejudice been car- 
 ried on this subject, that in cases of deafness in 
 early childhood, where much might have been 
 done, aiid the misfortune of settled disease in a 
 great measure averted, no attempt has even been 
 made to ascertain the defect, or try the smallest 
 means of relief, under the fallacious, and unfor- 
 tunate idea for the sufferer, that he will out- 
 
XXV11 
 
 grow the disease, or that the organ will acquire 
 an acuteness or increased powers as life advances, 
 which it does not possess at that period* 
 
 No opinion deserves more to be condemned, 
 or is more against the interest of society ; there 
 are indeed diseases of this nature, but they are 
 of the constitutional class, and depend on a 
 general fault of habit, they are not local, or af- 
 fections of one part* Thus scrofula or king’s 
 evil, as puberty advances, and the system 
 acquires greater tone and firmness from the 
 changes which take place at that period, loses 
 much of its virulence and morbid action ; and, 
 therefore, in a certain degree, the constitution 
 may be said, as it acquires strength, to out-grow 
 the disease ; but even here it is found that un- 
 less medicine lend its aid, numerous victims 
 would be lost, before the salutary time of life or 
 out-growing era did arrive. 
 
 This popular prejudice may be considered as 
 d 2 
 
XXV111 
 
 one cause that impedes the progress of medicine, 
 for it prevents patients applying to the practi- 
 tioner on the commencement of a malady, — the 
 idea of nature curing diseases in general, though 
 proper to be entertained to a certain length by 
 a professional character, should be opposed as a 
 general opinion, from conveying a want of con- 
 fidence in a science, which is justly considered 
 as the most useful. 
 
 The diseases of the ear, like those of other 
 parts, are often constitutional ; and the general 
 treatment of the constitution will, therefore, in- 
 fluence the malady of the particular part. Thus 
 a certain well known malady in its constitu- 
 tional form and ultimate stage, attacks the ear, 
 and deafness is produced by this specific cause. 
 
 The same course of medicines that remove 
 other constitutional symptoms, has an equal 
 effect on this organ ; and if there is no other 
 constitutional symptom but deafness, then em- 
 
XXIX 
 
 ploying internal medicines, according to the 
 regular method observed, will remove this com- 
 plaint. 
 
 % 
 
 If the stomach also is the centre of sympathy 
 to the whole machine, as generally admitted, 
 there is no doubt that the proper attention to it, 
 and that of the bowels, will do much to remove 
 diseased action connected with accumulation ; 
 hence the antiphlogistic treatment succeeds even 
 in cases of apparent weakness, by rousing and 
 invigorating the action of these primary orgarfe, 
 which is soon extended to the rest of the system, 
 and a full play given to the circulating and 
 secreting powers. 
 
 Various other instances might be adduced, all 
 tending to show that there are different morbid 
 changes of this organ, as well as of the others, 
 which are curable by a general treatment acting 
 upon the constitution, and thus indirectly ef- 
 fecting the part. 
 
XXX 
 
 Nay, even the most difficult of the whole of 
 this class of diseases, that which is termed ner- 
 vous deafness , may, as we find in its first stage, 
 be arrested in its progress, and thus rendered 
 curable. 
 
 It is curious to remark, that though the struc- 
 ture of the ear has occupied the attention of 
 the most ancient anatomists and medical writers, 
 little advantage has been derived from their 
 researches in a practical point of view. We find 
 in examining the early authors that Alcmeon in 
 particular, an illustrious Crotonian philosopher, 
 studied this organ : he lived shortly after the time 
 of Hippocrates, who flourished 400 years before 
 the birth of Christ. Aristotle frequently quotes 
 the anatomical ideas of Alcmeon, and in Scali- 
 ger’s edition of that author’s works, the Stagvrite 
 expressly devotes his time to confute the no- 
 tions of Alcmeon. Aristotle himself treats the 
 subject of this organ of sense more correctly, 
 for we find him dividing the external ear into a 
 
XXXI 
 
 pars innominata and lobus, which he says are 
 wholly composed of cartilage and flesh ; the 
 inner part he likens to a shell, from which there 
 is no passage into the brain, but one into the 
 cavity of the mouth, meaning the tube which 
 Eustachius took the credit of discovering. But 
 without entering into a minute detail, it may 
 be sufficient to observe, that the following is a 
 numerous list of ancient authors who have all 
 treated on the ear, though little advantage can 
 now be derived from the perusal of what they 
 have left us. 
 
 In Nemesius* work, who flourished, according 
 to Mercurialis, in the times of Gratian and 
 Theodosius, about 150 years after Galen, we 
 learn he wrote on, the senses, and in cap. x. de 
 Auditu. Also Bernardus Gordonius may be 
 consulted, p.291 de Aare. — Bartholomaeus An- 
 glicus de v. sensibus in totidem capitibus. — 
 Nicolaus Nicolas, Serm. 3, tract, primi, cap. v. 
 de Sens it, Audit us. — Johannes Matthseus de Gra- 
 
XXX11 
 
 dibus, de Anatomia Auris , c. 103. — Johannes 
 Anglicus, otherwise Johannes de Gadisden, de 
 Anatomia Aurium . — Likewise Alexander Achil- 
 linus; this author first gave the names of malleus 
 and incus to the two bones in the ear, and 
 Jacobus Berengarius, commonly called Carpus, 
 also notices these two bones adjacent to the 
 tympanum, which move, he says, by the percus- 
 sion of the air, and thus occasion sound. — Nico- 
 laus Massa likewise ascribes the discovery of 
 these two bones to Achillinus, Vide Epist. 5. — 
 Folius, Cassebohm, and Buchner, also wrote on 
 the ear, but are authors of a more modern day. 
 
 From the ancients, when we revert to modern 
 times, we have to remark with some regret that 
 the published works on this subject are few in 
 number, and are very incomplete. Duverney, 
 among the French, is the only author who has 
 treated the subject scientifically, until our own 
 time, when Dr. Monro, of Edinburgh, first pub- 
 lished his very accurate Treatise on the Anatomy 
 
XXX111 
 
 of the Ear ; and was followed by the w ork of 
 the late Mr. Saunders, which, besides the ana- 
 tomy, elucidated the diseases of the ear, and 
 introduced into this department of surgery con- 
 siderable improvement. His work, however, is 
 more adapted to the profession than for gene- 
 ral reading ; and as it is of importance that 
 those who unfortunately labour under a defect 
 of hearing, should have some knowledge of the 
 particular causes of the disease, the Author 
 flatters himself that the present Work will be 
 found an acquisition of no small value to those 
 for whom it is more especially intended. 
 
 The Work is necessarily concise ; but any 
 gentleman, desirous of further investigating this 
 interesting subject, may have an opportunity of 
 so doing, by attending the lectures of the Au- 
 thor, and the practice of the Royal Dispensary. 
 
 \ 
 
 E 
 
’ 
 
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 ' ; 
 
 ' 
 
 ' 
 
 > • 
 
 - 
 
 . 
 
 
 
 
 
 
TREATISE, &c. 
 
 CHAP. I. 
 
 Of the Structure and Uses of the different Parts 
 of the Ear. 
 
 A hollow cavern seems the general structure 
 of the organ of hearing, as best fitted for re- 
 ceiving, and reflecting sound. 
 
 So necessary is this cavernous shape of the 
 
 external ear to the reception of sound, that we 
 
 are told the celebrated tyrant of Syracuse, 
 
 Dionysius, caused a cavern to be formed in a 
 
 rock, corresponding to the shape of the human 
 
 ear, where he used to confine his state prisoners ; 
 
 e 2 
 
2 
 
 and from the strong vibration, and echoes of the 
 sound, he was enabled to learn the secret con- 
 versations they held, and thus condemn or v 
 acquit them accordingly. 
 
 In the different tribes of animals, it is liable 
 to considerable varieties in the appearance 
 and manner of its formation, and in its ap- 
 pendages. 
 
 In man it is more perfect in its structure, than 
 in any other animal ; and it is, also, of more 
 importance to him than to any other of the 
 creation. 
 
 All animals, as far as we know, possess this 
 sense ; it was formerly doubted with respect to 
 fishes. The organ of hearing in fishes, w r as first 
 discovered by the late Mr. John Hunter, and is 
 prosecuted at considerable length in his work 
 on the organ of hearing in fishes, by the late 
 Professor Monro, of Edinburgh. Thus the 
 
modern researches and discoveries in compara- 
 tive anatomy, have sufficiently established their 
 possession of this sense, as well as the other 
 classes. 
 
 The impressions the organ of hearing receives, 
 are conveyed through the medium of air, which 
 acquires from the action of the body communi- 
 cating sound, a tremulous motion or vibration ; 
 and as these motions or vibrations succeed each 
 other, sound is impressed or directed to the thin 
 membrane stretched obliquely across the audi- 
 tory passage, named the tympanum, where it 
 produces a similar motion, which latter motion 
 carried on, excites a corresponding feeling in 
 the mi rid . 
 
 That sound can only be conveyed through 
 the medium of air, is fully confirmed by the ex- 
 periments of the diving-bell ; for if a sonorous 
 body is placed in it, as a bell for example, in 
 consequence of its being exhausted of air, no 
 
4 
 
 sound is produced, nor can the ringing of the 
 bell be heard. 
 
 Though hearing is more perfect in man than 
 in any other animal, it is not so at the period of 
 birth ; an infant hears at first very imperfectly, 
 and only strong sounds ; but this arises, in part, 
 from the passage, or meatus externus, being 
 covered with a viscid mucus, or discharge from 
 the ceruminous glands of the ear, in a similar 
 manner as the meconium fills up the intestines: 
 on the removal of this layer or deposition, the 
 sense soon appears perfect, but not so strong as 
 at an after period of life. Indeed, as we find 
 the meconium, with some children at birth 
 possesses a morbid viscidity ; so in the same 
 manner the secretion most analogous to it will 
 partake of a similar state, and may, therefore, 
 be suspected where congenital deafness occurs 
 by examining the state of the first passages, or 
 primes vice. 
 
 In all animals, the ear is divided into an ex- 
 
5 
 
 ternal and internal part, and the difference in 
 the structure of the organ of hearing is greater 
 in the external ear than in the internal. 
 
 In quadrupeds this difference of structure is 
 more conspicuous than in the rest, and this 
 difference or variety seems intended to adapt 
 the animal the better for its particular circum- 
 stances or mode of life. 
 
 On examining the. external ear in quadru- 
 peds, it is found to resemble the oblique sec- 
 tion of a cone, from near the apex to the base. 
 Hares, and other animals exposed to danger, 
 and liable to be attacked by man or beasts of 
 prey, have large ears, and they are particularly 
 directed backwards ; while their eyes at the 
 same time, full and prominent, warn them of 
 any danger in front. Rapacious animals, on 
 the contrary, have their ears placed directly 
 forwards, as is observable in the lion, the tiger, 
 the cat, and others. ~S\ here the peculiar nature 
 
6 
 
 of animals is such as to require that sound be 
 distinctly heard from a low situation, as, for 
 instance, slow hounds and others, they will be 
 found to have either large pendulous ears, 
 or to have them flexible, since they move their 
 heads with more difficulty than man. 
 
 Much advantage may be taken of this cir- 
 cumstance in the construction of mechanical 
 contrivances for assisting hearing ; some ani- 
 mals keep their head to the ground, as if im- 
 pressing the sound more strongly on the organ ; 
 and in the case of deaf persons, such contri- 
 vances should be made nearly of a length to 
 touch the ground, which would give ample 
 compass for the reception and retention of 
 sound. 
 
 Fowls, again, differ from quadrupeds in hav- 
 ing no external ear ; but in place of it there 
 is a tuft of very fine feathers, which covers the 
 passage to the ear ; this covering allows the 
 
7 
 
 sound to pass easily through ; and it also pre- 
 vents any insects, or external matters which 
 might prove a source of injury, from getting 
 into it. 
 
 To fowls an external ear would have been 
 inconvenient, as causing an obstruction in the 
 course of their flight, in passing through 
 thickets, and other nearly impervious places. 
 In their auditory passage also there is situated 
 a liquor to lubricate it, and from its disagree- 
 able quality, to prevent the entrance of insects. 
 
 This secretion of the ceruminous glands in 
 man, is of the first consequence to the organ 
 of hearing, and should be always kept in view 
 in judging of its diseases ; from the moment, 
 these glands are formed, even before birth, 
 as may be seen on dissection, their secretion 
 is poured out, and accordingly after birth an 
 accumulation in the ear is a frequent source 
 of deafness till removed ; it varies in quan- 
 
 F 
 
8 
 
 tity in different individuals, according to 
 habit of body and other circumstances, in 
 the same manner as happens in the quantity 
 of the other secretions, which, in a certain de- 
 gree, are influenced by constitution, mode of 
 life, and a variety of other causes ; it is a very 
 frequent source of deafness, and in all cases 
 should be strictly inquired into. 
 
 On examining the different tribes of animals, 
 we find that fishes, as already noticed, have a com- 
 plete organ of hearing, and equally perfect as 
 that of the other classes. It is well known, that 
 the ear of the Whale kind strongly resembles 
 in its structure that of man. It has been exa- 
 mined minutely bj 7 Dr. Tyson #nd Dr. Cowper, 
 and still more accurately by Professor Monro. 
 A small round hole is the aperture to a long 
 external opening, or meatus, which terminates 
 in a concave membrana tympani, connected at 
 the bottom with a chain of small bones, as in 
 the human subject, and having also a cochlea, or 
 
9 
 
 internal ear, with semicircular canals. The 
 tympanum at the bottom is remarkably large, 
 and communicates freely with the other cavities. 
 There is also a tube, similar to the Eustachian 
 one, which gradually enlarges as it reaches to- 
 wards the tympanum. Thus, while the whale 
 floats on the surface of the ocean, the several 
 parts of his ear receive the same impression as 
 that of man ; but to fit him peculiarly for hjs 
 situation of occasionally diving deep, the ex- 
 ternal meatus is both small, and he has also the 
 power of shutting it at pleasure, which is par- 
 ticularly" conspicuous in the largest whales that 
 possess a small hard body within the meatus, 
 upwards of an inch in length, attached by its 
 small end to one side of the passage, which 
 serves as a valve to shut the ear when diving 
 deep, and thus prevents over distension and 
 rupture of the membrane of the tympanum : 
 Nor is the ear in the skate less perfect than in 
 the species of the whale. Two oriflces at the 
 
 upper and back part of the head present, which 
 
 f 2 
 
10 
 
 are the external meatus, and form a passage 
 into a sac or vestibule, which again communi- 
 cates into a smaller one, and at the same place 
 into a common canal. These sacs are filled 
 with a soft cretaceous matter, and this matter 
 seems to pervade every part of the internal ear, 
 as necessary to render the impression complete. 
 All these cavities are furnished with large 
 nerves, larger in proportion than those in the 
 human ear, and the only parts wanting here are 
 the membrane of the drum and cavity of the 
 tympanum, which were unnecessary when sound 
 is conveyed through a different medium than 
 air. Thus in them there is a vestibule and 
 cochlea, corresponding to similar parts of the 
 internal ear in man. There is also distributed 
 upon these sacs, a part of the auditory nerve, 
 resembling what is termed the portio mollis , or 
 branch of the seventh pair of nerves, in the 
 human subject : they have likewise semicircular 
 canals, a leading part of the internal ear, filled 
 whh a fluid which communicates with these 
 
11 
 
 sacs ; and they have also an external pas- 
 sage, which communicates with this internal 
 part. 
 
 In the cod species, instead of this soft creta- 
 ceous substance, I have noticed, there is found 
 a hard crustaceous stone ; but there seems no 
 appearance of an external passage, as in the 
 skate. 
 
 The whole organ seems to consist in them of 
 three semicircular canals and a sac of consider- 
 able size, in which is lodged this crustaceous 
 stone, and on it is expanded a considerable 
 nerve, in a neat and elegant manner. A viscid 
 humour, is likewise every where present, and 
 seems essential for the purpose of hearing in 
 this species of fish. 
 
 In prosecuting our inquiries farther, the ear 
 has been discovered in insects ; it lies at the 
 root of their antennae, or feelers, and can be 
 
 
12 
 
 distinctly seen in the lobster, and some others 
 of the larger kind. 
 
 In the sea tortoise, the frog, and other amphi- 
 bious animals, its structure is peculiar, by there 
 being - no external meatus, but an expanded 
 Eustachian tube at the back part of the roof of 
 the mouth, near where the under and upper 
 jaws articulate. This tube has a winding course 
 behind the upper jaw, and leads to a large 
 cavity resembling the cavity of the human tym- 
 panum, covered by the skin of the temple and 
 a tough substance. The latter then passes into 
 the bottom of the tympanum, and next into a 
 smaller cavity filled with a watery humour, and 
 last it opens into a third cavity, having three 
 semicircular canals, and a sac containing a soft 
 cretaceous substance, on the membrane of which 
 are distributed the nerves. Thus making a 
 comparison of it with the human ear the 
 tough substance or cartilaginous body supplies 
 the small bones of our ear, and the membrane 
 
13 
 
 to which it is connected is analogous to the 
 
 ° ' \ 
 
 membrane of the foramen ovale. The sac and 
 semicircular canals and nerves exactly resemble 
 the human labyrinth, or internal ear. 
 
 On the whole, the more we extend our ex- 
 amination of this organ of hearing , we shall find 
 it so constructed, in every class, as to be pecu- 
 liarly adapted to the mode of life, and other 
 circumstances connected with the situation of 
 the animal. 
 
 Man has the most perfect external ear of all 
 - animals ; as he must hear sounds equally from 
 all quarters, and especially such sounds as are 
 transmitted from his own height, so his ex- 
 ternal ear is both large, and placed in a vertical 
 manner, turned somewhat forward. But to 
 compensate the animal when compared with 
 man, the former in general possesses, in this 
 respect, a greater power of motion, and is fur- 
 nished with a greater number of muscles. Thus 
 
14 
 
 animals can direct or apply the cone of the ear 
 to the sonorous body without moving the head. 
 
 When the motion of the external ear takes 
 place in man, which has been known in some 
 rare instances, it does not seem to add any thing 
 to the perfection of the sense, as it does in them. 
 
 In describing the human ear, it is divided 
 into three parts, the external ear, the interme- 
 diate, and the internal. 
 
 The external or outward ear is designed by 
 nature to stand prominent, and to bear its pro- 
 portion, in the symmetry of the head ; but in 
 Europe it is greatly flattened by the pressure 
 of the dress. It consists of elastic cartilage, 
 formed with different hollows, or sinuosities, all 
 leading into each other, and finally terminating 
 in the concha, or immediate opening into the 
 tube of the ear. This form is admirably adapt- 
 ed for the reception of sound, for collecting 
 
15 
 
 and retaining it, that it may not pass off, or he 
 sent too rapidly to the seat of the impression. 
 
 The intermediate ear displays an irregular 
 cavity, having a membrane stretched across its 
 bottom ; and this cavity has a communication 
 with the external air, through the tube which 
 leads into the fauces, or throat. The tympanum, 
 or drum, which stretches across it, is intended 
 to carry the vibrations of the atmosphere, col- 
 lected by the outer ear, to the chain of bones 
 which form a peculiar mechanism in the tym- 
 panum. 
 
 The internal ear may be considered as the 
 actual seat of the organ : it consists of a nervous 
 expansion of high sensibility, the sentient ex- 
 tremities of which are spread in every direction, 
 and in the most minute manner, inosculating: 
 with each other, and forming plexus, all for the 
 purpose of increasing sensation. 
 
 G 
 
16 
 
 Here also the sound is collected and detained, 
 which the mastoid cells and cochlea present. 
 To this apparatus is added the presence of a 
 fluid, contained in sacs and membranes ; and 
 as this fluid is in large quantity in some ani- 
 mals, there is no doubt it is intended as an 
 additional means for forcing the impression ; 
 and the known influence of water, as a power- 
 ful medium, or conductor of sound, strengthens 
 the idea. The internal ear of man, therefore, 
 has all the variety of apparatus which is only 
 partially present in the other classes of crea- 
 tion ; and its perfection is best judged of, by 
 considering the variety which the internal ear 
 of other animals exhibits. The internal ear of 
 some animals, we find, consists of little more 
 than a sac of fluid, on which is expanded a 
 small pulp of nerve ; according to the situation 
 of this cavitjr, as it lives in water alone, or 
 is partly exposed to the air, so in the latter 
 it has an external opening with the ear or 
 otherwise. 
 
17 
 
 Ali terrestrial animals possess an external 
 opening leading to the internal ear. In fowls, 
 the ear is more of a cartilaginous consistence 
 than real bone. Hence any tremulous motion 
 impressed on the air is communicated merely 
 by the spring and elasticity of these cartilagi- 
 nous parts, which do not require, in order to 
 render the membrane of the ear tight, the same 
 power or action of the muscles. In the internal 
 ear the semicircular canals appear also very 
 distinct, the same as in man. In all animals 
 the internal ear is composed of a nervous ex- 
 pansion, contained in a hollow or cavity, and 
 assisted in its impression by a sac and fluid also 
 present there. 
 
 Hence of all species of deafness, that termed 
 nervous, or which affects the delicate nervous 
 expansion of the ear, is the most serious. 
 
 In consequence of the little success that has 
 
 g2 
 
18 
 
 attended the practice in nervous deafness, I 
 have conceived in such constitutions the quan- 
 tity of\air admitted by. the external ear is too 
 great ; and in order to produce an equal 
 balance between it and that admitted bv the 
 mouth, or through the passage of the usta- 
 chian tube, I have been induced, lately, to 
 adopt successfully a new mode of practice, 
 pursued on the Continent, which 1 shall have 
 occasion to mention in a subsequent part of 
 this Treatise. 
 
 Such being the structure necessary to the 
 collection and reception of sound, the latter, it 
 is observed, reaches the ear at equal distances, 
 and in an equal time. The common velocity 
 of sound is at the rate of 1142 feet in a second, 
 or about 13 miles in a minute. The knowledge 
 of the velocity of sound is of great use in de- 
 termining the distance of objects, at sea ; for if 
 a ship tires a gun, the light of w hich is seen 20 
 seconds before the report is heard, then it is 
 
19 
 
 known to be at the distance of 20 times 1142 
 feet, or about 4i miles. 
 
 Sound is also transmitted with equal velocity 
 when it traverses a large space, as when it 
 pervades a smaller one, without any diminution. 
 It is likewise transmitted with the same velocity 
 by night as by day, and when the sky is serene, 
 as when it is rainy or hazy. The degree of 
 noise it produces has also no influence in al- 
 tering the swiftness of sound, as it is equally 
 quick from a cannon as from a smaller instru- 
 ment. The velocity of it is, however, increased 
 by the aid of the wind when pursuing its direc- 
 tion, and lessened when the wind is in an 
 opposite quarter. 
 
 All sound is conveyed in waves or vibrations; 
 and where these meet with an obstruction in 
 their course, which is hard and of a regular 
 surface, on striking against it, they become re- 
 flected. If the ear be placed in the course of 
 
20 
 
 these reflected vibrations, it will perceive a 
 sound similar to the original one, which will 
 appear to proceed from a body situated in the 
 same position and distance as the reflecting 
 medium or obstacle, and exactly as the original 
 sounding body was before. 
 
 This sound is properly termed an echo, or a 
 reflecting one, thrown upon the ear by the ob- 
 structing body. 
 
 Reflected sounds, like reflected rays of light, 
 may be deflected, that is, magnified or turned 
 off, by contrivances similar in principle to those 
 made to increase the powers and extent of 
 vision. Thus, where there is an elliptical 
 cavity, sound uttered in one focus or point of 
 it will be heard much magnified in the other 
 focus ; of this a striking example is given by 
 the effect of sound in domes or vaults, as in- 
 stanced in the Whispering Gallery of St. Paul’s 
 Cathedral. It is on this principle the speaking- 
 
21 
 
 trumpet is constructed, so useful at sea ; which 
 in its form is a hollow parabolic conoid, having 
 a perforation at the top, to which the ear is 
 applied in hearing, or the mouth in speaking. 
 This principle of reflected sounds applies to 
 the ear itself. From the hard bodies situated 
 in the internal ear, the sound is evidently re- 
 flected back to the other parts, so that the 
 organ may be said to combine both principles 
 of receiving the impressions directly, and again 
 indirectly, by the reflection of the sounds w hich 
 strike on its harder or bony parts, thus applied 
 a second time, as it were, to the auditory 
 nerve. This idea is strengthened by the cir- 
 cular shape of the canals, where the sound 
 striking on one focus will be magnified as it 
 extends to the other, and in man they bear a 
 larger proportion to the cochlea than in the 
 quadruped or whale. 
 
 The same may be said in respect to the 
 cochlea, and all the internal parts of the 
 
22 
 
 organ, which are certainly formed for this re- 
 flection and reverberation of sound. Indeed, 
 it is only by comparing the structure with the 
 parts we know, that a just idea can be formed 
 of the peculiar and intricate fabric we observe, 
 as we cannot suppose any part of the mecha- 
 nism is made in vain. 
 
 Besides the effect of the hard and bony parts 
 of the ear in increasing the power of sound, 
 the tension of the different membranes seems 
 also an essential requisite. Thus various muscles 
 are so situated as to put the parts on the 
 stretch, that the sound striking upon them, 
 like the parchment of a drum, may, from this 
 tension, have its influence augmented. 
 
 In respect to its tension, the tympanum may 
 be also compared, not unaptly, to the strings 
 of a violin, or musical instrument, even more 
 properly than to a drum ; and as the state ot 
 tension and relaxation we find produce such a 
 
23 
 
 variety of sound with this instrument, so in the 
 same manner a variety of circumstances will 
 equally affect the tension and relaxation of 
 this part of the ear, and consequently vary its 
 powers of impression. 
 
 Its four bones act mechanically, in conse- 
 quence of the power of their muscles, which 
 strike like the key of an instrument, and pro- 
 duce a percussion of sound on the tympanum. 
 
 The knowledge of reflected sounds has never 
 yet been taken advantage of by the aurist, in 
 applying the principle to the construction of 
 artificial means for assisting the faculty of 
 hearing; the only principle attended to has 
 been, to increase the collection of sounds by 
 extending the canal of the auricle or external 
 ear, in the form of trumpets and cones ; but 
 if the farther power of reflected sound were 
 admitted into these instruments, as I have now 
 attempted to do, on the plan of the speaking- 
 
 ' H 
 
24 
 
 trumpet, a two-fold advantage would arise, 
 both in a greater collection of the vibrations, 
 and in their more powerful and repeated ap- 
 plication to the organ.* 
 
 Indeed, in constructing such instruments, 
 the length we may observe is the great point ; 
 for as in mechanics the powers of the lever 
 are increased by its length, so the strength of 
 the impression conveyed by the air will be 
 in proportion to the length, and also the 
 straitness of the tube through which it is 
 conveyed. 
 
 Besides the perfection attached to the struc- 
 ture of the human ear beyond that of other 
 animals, its nervous texture internally is of a 
 more delicate and sensible nature. Thus the 
 
 * Besides this instrument, in order to give every possible assistance to deaf 
 persons, the author has with much pains collected a variety of ingenious 
 mechanical contrivances, from the Continent, on the principle of improve- 
 ment, on some of which he has made important and useful alterations. 
 
25 
 
 nerves are even more acute or sentient than in 
 the other parts of the body. All the nerves of 
 the internal ear display a soft pulpy substance, 
 but are never seen in the form of a firm cord ; 
 and in the flexible and membranous parts, they 
 shew even a change of colour. This change is 
 like that the optic nerves undergo on enter- 
 ing the eyeball to form the retina, and the 
 term retina or net-work, is here properly ap- 
 plied, from the reticulated appearance they 
 display. 
 
 The auditory nerve also, as it enters the in- 
 ternal passage of the ear, is accompanied by a 
 larger artery than most of the other nerves, to 
 heighten the sensibility ; for increased circula- 
 tion has every where this effect ; and it also 
 forms into plexus, or combinations, for the 
 same purpose. 
 
 Though the use of the Eustachian tube 
 
 has been doubted, as conveying sound by the 
 
 h 2 
 
26 
 
 mouth, yet a simple experiment will convince 
 us, that it lias some influence in this respect ; thus 
 if a deaf person is to converse with another, 
 and a wire or other medium of communication 
 is made to pass to the mouth of each, by placing 
 its extremity between the teeth, the deaf person 
 will hear the conversation better than without 
 this assistance, which certain!}- proves that part 
 of the vibrations of sound is carried along the 
 wire into the mouth ; and applied to the ear, 
 through the Eustachian tube in the throat, 
 while a part also reaches the ear externally, 
 and is collected in the auricle in the usual 
 manner : this fact is farther proved by deafness 
 occurring from the obliteration of the passage 
 of the Eustachian tube, in consequence of 
 diseases in the throat, particularly in conse- 
 quence of ulcerations from a well know n spe- 
 cific cause. Besides, therefore, merely pre- 
 serving the balance of air between the external 
 and internal ear, it certainly has an influence 
 also in conveying sound ; and while the meatus 
 
27 
 
 externus admits its application one way, the 
 aperture of the Eustachian tube admits it, we 
 may conclude, in a certain degree, the other, 
 and may be considered as an accessary means 
 to increase the impression, driving the vibra- 
 tions of sound in different directions to one 
 point ; and hence also persons generally hear 
 best with the mouth open, when the opening of 
 the Eustachian tube is most expanded. The 
 same thing has been observed of deaf persons, 
 that they hear best when riding in a carriage, 
 probably from the air being carried with 
 stronger impressions to the ear. 
 
 s Indeed, this opening between the ear and 
 throat is one of great consequence, and one of 
 which much advantage may be taken in the 
 treatment of deafness ; in nervous deafness, I 
 am persuaded, too great a quantity of air, as I 
 have stated, is often admitted to the ear, which 
 appears from the confused noises complained 
 of, when it does not act with sufficient energy 
 
28 
 
 to allow the impression to be made. By les- 
 sening, therefore, the action of the air on the 
 external passage, and making it pass more for- 
 cibly by the internal, I am satisfied, deafness 
 may be cured. 
 
 When we examine next the nervous texture 
 of the internal ear for receiving the impression, 
 nature seems to have provided that the nerves, 
 as I have observed, should be here more acute 
 or sentient than elsewhere. 
 
 Nay, they often acquire a morbid acuteness 
 without disease. This is particularly the case 
 after childbed, and so acutely sensible is the 
 organ in this state, that there are many in- 
 stances of a sudden noise, producing syncope 
 and immediate death ; while in such cases, on 
 dissection, no traces of disease could be dis- 
 covered, and therefore, that this extreme sen- 
 sibility was the sole cause. 
 
29 
 
 From the same cause of its acuteness or deli- 
 cate feelings, its powers are also liable to sus- 
 pension, and perhaps this is the state of it, in 
 that deafness which often takes place after en- 
 gagements, both by sea and land, when the 
 tremendous noise acting upon it, exhausts and 
 destroys its powers. 
 
 On proceeding farther into our examination, 
 the nerves of the tympanum and other parts of 
 the ear, where this exquisite sensibility is not 
 so much required, display the natural texture 
 as firm cords, and consequently a less sensible 
 substance. All these circumstances shew that 
 hearing, or the impression of sound to produce 
 it, requires a higher degree of organization 
 than the other senses, and a more complex 
 mechanism. 
 
 In order to judge properly of the parts, more 
 essential to the organ, we must take the assist- 
 ance of the discoveries made by dissection. 
 
* 
 
 30 
 
 With respect to the external ear in man, 
 wherever it is completely removed, either by 
 accident or design, deafness ensues, although 
 its partial removal is not attended with this 
 imperfection. The external ear, therefore, or 
 something in its form to collect sound, is a 
 necessary division of the organ. 
 
 When we proceed internally, we find that a 
 partial destruction of the membrane of the tym- 
 panum is not accompanied with deafness; but 
 its total removal is always so : this partial de- 
 struction is proved from persons being able to 
 make the smoke of tobacco pass through the 
 throat by confining the mouth and nose, in 
 consequence of its entering the Eustachian 
 tube, and thus going out of the external ear, 
 which could never take place without an open- 
 ing, or perforation of the membrane of the 
 tympanum. 
 
 Ulcerations of 1 he ear in childhood, have fre- 
 
31 
 
 frequently this effect of destroying a part of 
 the membrane of the tympanum, and yet the 
 child, as he grows up, continues afterwards to 
 hear without any perceptible inconvenience ; 
 yet, in order to hear with ease, it seems neces- 
 sary that the membrane of the tympanum, even 
 though partially destroyed, should always pre- 
 serve a certain degree of tension. 
 
 For the membrane of the tympanum may be 
 compared to the parchment -of the drum, and 
 is the medium by which sound is impressed on 
 the organ, in the feme manner as the beating 
 of the parchment gives action and expression 
 to that instrument. 
 
 In proof of this, cases of partial deafness are 
 recorded where persons could only hear when 
 a strong sound, such as that of a drum, was 
 applied to the ear ; and on dissection in one 
 case of this kind, related in the French me- 
 moirs, no other cause appeared to produce 
 
 i 
 
32 
 
 deafness, but a highly-relaxed state of the 
 membrane. 
 
 Yet not only may the membrane of the tym- 
 panum be partially destroyed, and hearing pre- 
 served, but likewise the small bones of the 
 tympanum have been in certain cases lost, or 
 come away from ulceration, from a constitu- 
 tional or other cause ; but in such cases it 
 appears the stapes was always left, and thus the 
 openings of the fenestra ovata and rotunda, 
 were preserved, which prevented the escape of 
 sound from the labyrinth and internal parts ! 
 Where the stapes is removed by opening the 
 internal ear, deafness must unavoidably ensue. 
 
 With respect to the Eustachian tube, its 
 aperture into the throat seems indispensable 
 to hearing, and wherever closed from malcon- 
 formation or disease, deafness is a certain con- 
 sequence. I already mentioned its obliteration 
 happening in the throat from a particular dis- 
 
33 
 
 ease ; which is one strong reason for an early 
 attention to such complaints;* but the same 
 thing is apt to occur from a catarrh or common 
 cold, when it is violent and long continued. 
 
 After considering the tympanum and Eusta- 
 chian tube, I remarked in the internal ear, that 
 the presence also of a fluid appears indispen- 
 sable to the exercise of hearing. In all dissec- 
 tions of old persons who have been deaf for 
 years, on examining the internal ear, it has 
 been found totally dry, and wanting its secre- 
 tion, or that fluid I before mentioned, con- 
 tained in its sacs and membranes. Such a 
 state occurs frequently from age, yet it may 
 occur from particular circumstances ; especi- 
 ally after fevers, of which deafness is often a 
 consequence. 
 
 * The poison of these complaints has a peculiar action on the nervous 
 system, hence when the disease is latent in the habit, there is often a dullness 
 and inaptitude of all the nerves, particularly those employed in the more 
 active organs, to receive impression. 
 
 I 2 
 
34 
 
 The air, I have endeavoured to shew, is the 
 great medium through which sonorous bodies 
 act on the ear. Its entire exclusion, I have 
 already stated, prevents our hearing sound, 
 however strong; and on the same principle, 
 the condensation of air increases the force of 
 sound in a proportion to the degree of con- 
 densation. 
 
 Water is likewise an equally effectual me- 
 dium as air, and a bell rung under water is 
 heard with equal distinctness as in the air ; its 
 effect is strongly conspicuous in cases of echos 
 or reflected sounds, for where the sound has to 
 pass over a lake or sheet of water, before it 
 reaches the hard or obstructing body, it is much 
 stronger than in another situation ; a famous 
 instance of this is well known to travellers, in 
 the echo of Portici in Italy. 
 
 The well known experiments of Professor 
 Monro on this subject, deserve here to be no- 
 
35 
 
 ticed. He runs: a bell under water at various 
 distances, and found the transmission of sound 
 equally distinct as through the air, and often 
 stronger and graver. 
 
 From this general view, then, of the organ, 
 the parts strictly essential to hearing are, — 
 
 First. An external ear; # for in man, when- 
 ever this part is completely removed, deafness 
 is a consequence. 
 
 * The external ear can only be considered as accessary in its functions to 
 the internal ; and it was conceived by the Count de Buffon, that hearing 
 could take place without it. This he considered proved by the instances of 
 dogs, and other animals, from the whim of their owners, being occasionally 
 deprived of the external ear, and suffering no defect by the operation. But 
 though this fact may be true in young animals, and while the expansion of 
 the auditory nerve on the internal ear possesses its full powers and influence 
 to receive the impression of sound, yet it is clear that in the human subject, 
 such a loss would be severely felt ; which is confirmed by the advantage of 
 artificial means, in collecting the sound, and strengthening the power of 
 impression. 
 
 Besides, in cutting the external ear in animals, part of the muscles still 
 remains ; and by a natural instinct, the animal acts with the remaining part 
 with more energy, and applies it more eagerly and forcibly to the sonorous 
 body, than before their partial removal, which entirely condemns Buffon 's 
 assertion. 
 
* 
 
 36 
 
 Secondly. The membrane of the tympanum, 
 which may be partially injured, but never can 
 be completely removed, without producing 
 deafness. 
 
 Thirdly. The stapes ; for all the small bones 
 of the ear may be removed without causing 
 deafness ; but the stapes is the only one that 
 prevents the escape of sound from the internal 
 ear. 
 
 Fourthly. The aperture of the Eustachian 
 tube, as preserving the access of air through the 
 throat to the tympanum, and its renewal and 
 change in the organ ; and that this is a neces- 
 sary and essential part, is evident from the 
 structure of the ear in the tortoise and frogs, 
 which have no external ear, but an enlarged 
 Eustachian tube placed at the back part of the 
 roof of the mouth. 
 
 Fifthly. The presence of a fluid in the in- 
 
37 
 
 ternal ear, which is necessary to heighten the 
 acuteness of impression, and to render it ef- 
 fectual. 
 
 But it remains next to observe in what 
 manner the impression on these parts comes to 
 be made, or the tremor from sonorous bodies 
 communicated to the nerves of the internal ear. 
 In man, quadrupeds, and birds, besides the 
 impression communicated to the nerves of the 
 ear by the whole bones of the head, a distinct 
 impression may be conveyed to them in three 
 different ways : — 
 
 / 
 
 1. By the structure of the parts regulated by 
 their muscles, which connect the membrane of 
 the drum with that of the oval hole. 
 
 % By the action of the air contained in the 
 cavity of the tympanum, which air must com- 
 municate its tremor in two ways — by motion 
 from the membrane of the tympanum, and 
 
38 
 
 also by tremor of the external air communi- 
 cated to the membrane of the Eustachian 
 tube, and 
 
 3. By the medium of a watery liquor filling 
 the cavities of the vestibule, semicircular canals, 
 and cochlea, which transmits the tremor from 
 the membrane of the oval and round holes to 
 the portio mollis, or nerve of the internal ear. 
 
 Such, as I have endeavoured to describe it, 
 is the complex and minute structure of this 
 important sense ; and when we attend to the 
 intricacy of its parts, to the delicacy of its 
 texture, and to the numerous windings and 
 sinuosities it every where displays, we are 
 struck with wonder and admiration at the 
 nicety of its mechanism, and cannot be sur- 
 prised that the least change should produce on 
 it a deviation from the healthy state. 
 
 Nay, w hen we farther contemplate the varied 
 
39 
 
 organization of the ear in the different tribes of 
 animals, we shall in all of them find it admi- 
 
 V 4 
 
 rably fitted for their different situations and 
 characters ; and by a slight comparison of the 
 different tribes, we shall understand the reason 
 for its apparent difference of structure in each. 
 Thus the whale, though he would seem amphi- 
 bious, has the same formation of heart and 
 lungs as man, and is therefore obliged to 
 breathe frequently and regularly, and thus to 
 live chiefly on the surface of the ocean. Hence 
 his ear is constructed to receive sound from the 
 air by an external meatus. 
 
 But in the real amphibious tribe, when part 
 only of the blood passes through the lungs, and 
 which possess the power of breathing arbitra- 
 rily, or of plunging under water and ceasing 
 from breathing for a length of time, the ear is 
 so adapted as to receive the first impression 
 either from the air or from the water ; for by 
 means of an expanded Eustachian tube air is 
 
 K 
 
40 
 
 introduced into the cavity of the tympanum 
 when they breathe, and through it also the im- 
 pression is conveyed from the atmosphere, to 
 which their ears are generally exposed, to the 
 bottom of the ear with more force than it 
 would have been by the medium of a watery 
 fluid passed into the cavity of the tympanum. 
 
 In fishes, both living and breathing in water, 
 not only is the impression of sound on the 
 surface of the ear transmitted, but is conveyed 
 also by the same medium to the bottom of the 
 ear. Hence it is that they stand in no need for 
 a cavity of the tympanum or for a Eustachian 
 tube. 
 
 Semicircular canals are conspicuous at the 
 bottom of the ear in all fishes, similar in shape 
 and situation to those in quadrupeds, but they 
 are much larger and more extensive in their 
 surface, in order to compensate for the less for- 
 cible impression made by the water on them 
 than in man and quadrupeds by the air. 
 
41 
 
 Along with these semicircular canals there 
 are also sacs, which resemble the cochlea in 
 men, and answer for it in the same manner as 
 a short straight tube does in birds. The stones 
 or hard bodies in the ear of fishes also serve as 
 the bones in the human ear to render the im- 
 pression more forcible on the nerves that are 
 spread on the membranes that contain them. 
 In several fishes also which have an external 
 ear, the sound is conveyed by a watery viscid 
 liquor to the semicircular canals and sac con- 
 taining the cretaceous or stony matter. 
 
 Thus, the more we contemplate the varied 
 structure of this sense, the more we shall be con- 
 vinced it is the work of infinite power, and modi- 
 fied by a Supreme Being, who has adapted every 
 creature, whether animate or inanimate, for its 
 place. All our researches in anatomy serve to 
 point out this fact, but none more strongly 
 than the investigation of the different organs 
 of sense. A nervous expansion we find the 
 
 K 2 
 
42 
 
 universal medium, on which the impressions 
 are made, and through which they are con- 
 veyed. This being the case, all the senses may 
 be considered in a manner as resembling each 
 other, and only differing in their peculiar 
 modification, or what may be termed the 
 auxilary organization of the parts that tran- 
 smit the effect to the mind. 
 
CHAP. II. 
 
 Of the Diseases of the Ear. 
 
 Having in the Introductory Part pointed out 
 the necessity of an exclusive attention to the 
 diseases of the Ear as a particular profession, 
 and the parts of the organ essential to the 
 exercise of its peculiar functions ; I now pro- 
 ceed to examine its leading diseases, or those 
 imperfections which either impair, or produce a 
 total loss of hearing. For more clearly under- 
 standing their nature, they require to be ar- 
 ranged according to the particular parts of the 
 organ in which they are seated ; and they ac- 
 cordingly come to be divided into the diseases 
 
44 
 
 of the auricle, or external ear ; diseases of the 
 tympanum, or drum ; and diseases of the laby- 
 rinth, or internal ear. 
 
 Diseases of the External Ear . 
 
 The diseases of the external ear, like those of 
 every other part, partake of the nature of its 
 structure, and as this is neither important, 
 complex, nor extensive, these necessarily be- 
 come in a manner simple and confined; indeed, 
 as a cartilaginous basis with a cutaneous enve- 
 lope, the external ear is subject to the same 
 affections as other exterior parts. The chief of 
 which that require the more particular atten- 
 tion of the aurist, are inflammation and that 
 herpetic eruption which occurs so frequently in 
 children. 
 
 I. Of Inflammation. 
 
 On such a topic as inflammation it it diffi- 
 cult to advance any thing new, therefore I have 
 
45 
 
 merely collated those symptoms which my own 
 experience have verified. 
 
 The invariable effect of inflammation is to 
 enlarge the bulk of the part it attacks, and 
 w'hen this happens to be of a solid structure 
 that does not readily yield to the distension, 
 the attending inflammation is thereby aggra- 
 vated. This is what happens in the disease we 
 are treating of : in consequence of the dense 
 nature of cartilage the pain is vehement and 
 excruciating, and fever is the usual consequence 
 of such painful excitement. 
 
 Regarding the cure of this affection, the me- 
 thodus medendi differs in nothing from that 
 found effective in other inflammations. If the 
 attack be slight, a cooling lotion kept con- 
 stantly applied to the part, low diet and saline 
 purgatives are the most proper remedies ; but 
 where the disease is more acute, leeches must 
 be applied to the inflamed organ, and in order 
 
46 
 
 to procure an abatement of pain, an anodyne 
 draught may be administered at bed-time. 
 
 The success of resolution is known by the 
 gradual abatement of pain; but should the pre- 
 ceding means fail in their influence, then sup- 
 puration must be promoted, and the former 
 plan laid aside, substituting in its stead, warm 
 applications and poultices to the ear; but in 
 some constitutions, it may be observed, so rapid 
 is the process of inflammation in this part, that 
 suppuration is unavoidable. 
 
 My own experience confirms the remark of 
 an excellent writer, to wit, that when suppura- 
 tion occurs, the pus is generally vacated be- 
 tween the auricle and mastoid process of the 
 temporal bone ; or into the meatus auris. In 
 the first instance the abscess heals without 
 much difficulty from the ready exit the matter 
 finds, but in the latter case the aperture by 
 which it escapes into the meatus is sometimes 
 
47 
 
 so contracted, that the pus accumulates and 
 keeps up a source of painful excitement. The 
 contact of matter also in the contiguity of a 
 bone is apt to occasion caries, and consequent 
 exfoliation, hence it becomes a part of our 
 serious regard to prevent such occurrences; in 
 order to which, a free opening must be made 
 into the sinus and its orifice enlarged, or what 
 perhaps is better, let the point of a lancet be 
 thrust into the abscess behind the ear, the de- 
 pendent situation of which will permit the easy 
 discharge of the matter as soon as it is secreted. 
 
 The time of teething in young children, is the 
 period when this disease is most apt to occur ; 
 and hence its acuteness may be accounted 
 for, requiring often the palliative powers of 
 opium to lull the intense pain it occasions. 
 It is a disease more frequent in scrophulous 
 subjects than others, and thus the propriety of 
 early resolution, or subduing inflammation, is 
 pointed out. 
 
 L 
 
48 
 
 II. Herpes. 
 
 Another disease of the auricle, more frequent 
 than the former, is herpes. This consists in a 
 vesicular eruption set upon an inflamed base. 
 Usually from the situation of the part affected, 
 and the handling thereof, the vesicles are broken, 
 a copious foetid discharge takes place, and a 
 troublesome and tedious ulceration ensues ; this, 
 when it has continued for some time, induces a 
 thickening of the cutis covering the external 
 ear and lining the passage, and which, together 
 with the inspissation of the discharge in the 
 meatus, so narrows the entrance that a tem- 
 porary deafness is produced, from the obstruc- 
 tion offered to the free ingress of sound to the 
 tympanum. 
 
 In the treatment, though the correcting of 
 constitutional acrimony be the principle, the 
 state of the part at the same time requires a 
 primary attention. The inspissated matter is 
 
49 
 
 to be removed by properly syringing the pas- 
 sage with soap and water, and, to do it com- 
 pletely, the choice of a syringe is a matter of 
 consequence. A syringe of a moderate size will 
 answer the purpose best, the power of which is 
 not too great ; and the operation should never 
 be trusted to any but a skilful hand, On pro- 
 perly cleansing the ear, an alterative injection 
 is to be employed instead of the soap and 
 water, and the constitution corrected by altera- 
 tive medicines in small doses, until the cure is 
 completed. 
 
 The period for a cure may extend from 
 two or three weeks to the same number of 
 months, according to the circumstances of the 
 case, in respect to its severity and constitu- 
 tional nature ; and this treatment should be 
 continued in a regular and steady manner in 
 order to be successful. 
 
 L 2 
 
50 
 
 III. Morbid Septum of the Passage. 
 
 Congenital malformations occur occasion- 
 ally in new-born infants, and to such a degree 
 as to deserve the appellation of monstrosities. 
 Less degrees of this preternatural occurrence, 
 being of minor importance, are not usually thus 
 designated : of this nature are septa where 
 apertures ought to be. These occur in various 
 openings, and at times are discovered in the 
 external ear. A septum is found to extend 
 across the meatus, and necessarily excludes the 
 vibration of sound on the tympanum from 
 without ; hence deafness is the natural conse- 
 quence. This extraneous formation is also the 
 effect of disease, and is, though seldom, the 
 sequence of the ulcerative process. This defect 
 more frequently arises from a diseased tympa- 
 num, than from any other cause, where the sup- 
 puration is considerable, and much matter has 
 been forced out into the passage. 
 
51 
 
 The following is the usual progress of the 
 disease : — The patient, after a puriform dis- 
 charge from the ear, feels a sudden and consi- 
 derable increase of deafness, to which he has 
 been in a certain degree subject in consequence 
 of the original complaint. During this original 
 state of deafness, he has been also sensible, on 
 blowing his nose, of air passing at times through 
 the meatus ; but the puriform discharge having 
 now ceased, and the patient being also no 
 longer able, on blowing the nose, to feel air 
 escape through the passage, the existence of a 
 septum becomes undoubted. To this may be 
 added the sensation of a particular fulness of 
 the tympanum. 
 
 If, under these circumstances, the patient be 
 placed in a clear light, and the ear examined, 
 a septum will be perceived. To remove this 
 impediment, the septum is to be pierced and 
 lacerated ; when the hearing will be restored 
 to the same degree in which it prevailed under 
 
52 
 
 the diseased tympanum, and before the septum 
 was formed. 
 
 So quick is the hearing restored, that, imme- 
 diately after the operation, the ticking of a 
 watch has been heard at a considerable dis- 
 tance, which could not have been perceived 
 before, even when close to the ear. 
 
 After the operation, much attention is neces- 
 sary to prevent the closing of the sides of the 
 aperture, and the septum being re-produced. 
 
 IV. Of Polypi of the Ear. 
 
 All secreting surfaces are liable to excres- 
 cences. They are found in the uterus, but their 
 most common seat is in the mucous membrane 
 lining the cavernous structure of the nose. In 
 like manner the meatus of the external ear is 
 subject to excrescences : these are usually the 
 consequence, in the latter instance, of a diseased 
 
53 
 
 tympanum, and they are rarely met with except 
 in this source. They have been aptly com- 
 pared to syphilitic warts, and like these they 
 are generated from irritation. 
 
 The treatment to remove these polypi is the 
 same as that employed for excrescences else- 
 where: when small they are best extracted with 
 a pair of forceps, and the root or part, to which 
 they adhered, afterwards touched with the ar- 
 gentum nitratum, or lunar caustic. In intro- 
 ducing the caustic, care must be taken not to 
 carry it so far as to injure the tympanum ; and 
 with this caution the treatment will be gene- 
 rally successful. 
 
 Where the polypus is appended to a small 
 ceruix or neck, a ligature is the preferable mode 
 of removing it. The operation also is less 
 alarming to the patient, and at the same time 
 equally effectual as the forceps or knife. 
 
54 
 
 Y. Inspissated Cerumen. 
 
 The most frequent cause of deafness, con- 
 nected with the state of the external passage, is 
 that arising from collected cerumen or wax ; a 
 due secretion of the passage is absolutely neces- 
 sary to keep it in a healthy condition, as well 
 as to preserve it from external injury. A de- 
 fective, or too profuse, secretion is equally the 
 cause of deafness, and the cerumen frequently 
 becomes indurated and inspissated to such a 
 degree as to cause obstinate dullness of hearing. 
 
 The natural secretion of the ear varies in dif- 
 ferent individuals. In some it is copious, in 
 others sparing in quantity ; how it is excreted 
 has puzzled physiologists to explain, and the 
 usually received opinion is that the fresh secre- 
 tion propels the older, and that this is assisted 
 by the occasional dependent position of the ear. 
 Y ere it for me to add another, and perhaps 
 
 I 
 
55 
 
 more powerful, expelling force to the above, it 
 would be that of the action of manducation. 
 Any one may convince himself of this power by 
 putting his finger into his ear and imitate the 
 act of mastication. Nature never made a func- 
 tion but she made it perfect, and in the pre- 
 sent example we have an happy, though subsi- 
 diary, instance of her ingenuity — where the 
 the same act that receives and prepares the food, 
 is at the same time expelling the cerumen from 
 the ear. 
 
 It has often surprised me to witness how 
 small a portion of hardened wax will occasion 
 deafness, for it is the induration and not the 
 quantity of wax which occasions deafness : this 
 when accumulated on the membrane of the 
 tympanum, of corpse, interferes with the vibra- 
 tions of that membrane, and when large in 
 quantity it wholly obstructs the passage. 
 
 The symptoms that particularly mark this 
 
 M 
 
56 
 
 complaint are the following - . With the general 
 sense of deafness, there is combined the impres- 
 sion of noises in the ear, consisting either of a 
 particular confused sound, or a heavy sensation 
 like the noise of a hammer : these sounds pre- 
 vail most while eating. 
 
 On ascertaining the presence of these symp- 
 toms, and following it up by an examination 
 of the ear, the cause of deafness will be easily 
 detected. 
 
 The best means of relief is simply washing 
 out the passage with warm water, by means of 
 a syringe, which Dr. Haygarth found the best 
 solven of ear-wax, and the only means necessary. 
 
 On its removal, the complaint is instanta- 
 neously relieved, and the hearing restored. 
 When there is no defect or imperfection of the 
 organ, its removal generally produces a slight 
 irritation of the ear, in consequence of the 
 
57 
 
 strong excitement occasioned by forcing the 
 fluid into the passage ; but this soon ceases, 
 without any unpleasant effect. This disease, 
 however simple, has been often mistaken or 
 overlooked, and the cause supposed to lie deep 
 in the structure of the organ, whilst, in fact, it 
 arose merely from the source above pointed 
 out; which shows the necessity, in all cases of 
 deafness, of ascertaining, by an accurate exami- 
 nation, whether such a mechanical cause does 
 exist. 
 
 VI. Accidents. 
 
 From its situation the external passage is 
 subject to occasional accidents, or other mecha- 
 nical causes acting upon it, than inspissated 
 cerumen. 
 
 Thus, in cases of children, small bodies, as 
 
 peas, cherry-stones, pins, &c. have got into the 
 
 ear, where, exciting inflammation, they often 
 
 M 2 
 
58 
 
 occasion considerable pain before they are re- 
 moved. A number of remarkable cases of such 
 accidents will be found related by authors, and 
 one in particular, related by Hildanus, where a 
 bead or ball of glass lodged in the passage and 
 produced delirium. 
 
 The great art in extracting them, is to be 
 cautious not to push them deeper ; they are 
 best taken out by a pair of small forceps, and 
 a little oil may be dropped into the ear before 
 making the attempt. 
 
 In the same way, insects at times get into the 
 ear, which produce the most unpleasant feelings 
 in the part, as well as great noise, and often 
 actual pain ; the best way of removing them is 
 to drown them, by filling the passage with mild 
 fluids, as water or oil, by means of a syringe, 
 and thus washing them out. Acrid liquors are 
 improper ; for, in the endeavour to avoid them, 
 the insect gets deeper. The motion is often so 
 
59 
 
 severely felt by children, as to produce a stale 
 little short of delirium ; after the removal, a 
 little oil of sweet almonds is the best applica- 
 tion, to soothe the irritated part. Even a little 
 oil, in the first instance, will destroy the insect. 
 
 VII. Congenital hispissation of Cerumen. 
 
 This is a disease more frequent than is gene- 
 rally supposed. All the secreting passages in 
 children, at birth, are lined with a tenacious 
 layer of this natural secretion ; it is seen in the 
 bowels, in the state of meconium ; and no less 
 in the ears, in the state of viscid wax : the rea- 
 son of this is, that the parts of the concha and 
 passage are narrow, and such an accumulation 
 is essential to defend the tympanum from the 
 waters of the amnios. 
 
 In all apparent deafness of children, the ears 
 should be examined in order to trace whether 
 it is connected with this cause. 
 
CHAP. III. 
 
 Diseases of the Tympanum. 
 
 I. Puriform Discharge of the Tympanum. 
 
 The first disease of the tympanum is that 
 named, from its leading symptom, its “ Puri- 
 form Discharge,” which has been acurately and 
 minutely described by Mr. Saunders. Indeed, 
 his account so precisely concurs with wliat 1 
 have had so many opportunities of confirming, 
 that I shall take his description of its nature, 
 progress, and effects, as my guide. 
 
 The discharge which issues from the ear is 
 
61 
 
 thin and ichrous, and its nature is so virulent 
 as slightly to corrode a silver probe ; this it 
 stains with a yellow colour, and it is occasion- 
 ally tinged with blood, from the effects of cor- 
 rosive ulcerarion which is going on in the in- 
 terior. The hearing naturally becomes im- 
 paired from the injury produced by the disease, 
 and in many cases it is wholly lost. 
 
 The leading criterion that marks the exist- 
 ence of this disease is the passage of air, on 
 blowing the nose, by the meatus externus : this 
 of course never can occur, but where there is a 
 perforation in the membrana tympani. But this, 
 although a pretty constant symptom, must not 
 be looked upon as an absolutely necessary cha- 
 racteristic, for where the inflammation that 
 induced the suppuration has first of all ob- 
 structed the Eustachian tube, this consequently 
 shuts up all communication between the mouth 
 and external meatus, even though the membrane 
 of the tympanum be pervious and ulcerated. 
 
62 
 
 V? hen, therefore, the air passes out of the 
 external ear, accompanied with a puriform dis- 
 charge, we can no longer doubt of the nature 
 of the complaint ; still, as this criterion may be 
 wanting, from the cause we have noticed, it 
 becomes incumbent on us that we examine the 
 ear itself. 
 
 In order to do this, let the patient’s head be 
 turned towards a good light on the side dis- 
 eased, so as to permit the rays of light to fall 
 on the bottom of the meatus externus, when we 
 shall be enabled to perceive the part morbidly 
 disorganized, and thus determine the nature and 
 extent of the injury ; or where from some cause 
 ocular demonstration is unattainable, a probe 
 being inserted into the ear and passed down to 
 the membrana tympani, the peculiar feel which 
 this communicates, if sound or otherwise, will 
 ascertain the extent and progress of the disease. 
 But this requires the tactus eruditus , or touch of 
 experience, which nothing except practice can 
 give. 
 
63 
 
 The diagnosis of this disease is simple, and 
 unless it be for the herpetic affection before 
 mentioned, it cannot well be confounded with 
 any other. This is a matter of some importance, 
 since in the one we may almost invariably pro- 
 mise a complete cure, whereas in the latter 
 caution must be used in pronouncing any such 
 favourable prognosis. 
 
 This affection of the tympanum is produced 
 by various causes ; diseases of the throat are the 
 most frequent. Thus the Scarlatina Maligna, 
 or Scarlet Fever, combined with an affection of 
 the throat, frequently occasions the tympanum 
 to suffer, in consequence of the gangrene, or 
 sloughing, which takes place: even the bones of 
 the internal ear are at times thrown off ; and 
 the patient, if lie survives the fever, is left com- 
 pletely deaf. 
 
 The disease, also, often succeeds the ear-ache, 
 
 or inflammation of the passage extending to 
 
 N 
 
64 
 
 the tympanum ; and if the inflammation is not 
 subdued by resolution, then the tympanum 
 and mastoid cells become filled with pus, or 
 matter. 
 
 The pus comes to be discharged by ulcera- 
 tion, in large quantity, after the patient has 
 suffered most intense pain. During its progress, 
 the discharge of matter produces, for a time, a 
 relief of symptoms ; but, as the disease goes 
 on, fresh matter is formed, and continues to 
 ooze from the passage. 
 
 The symptoms that peculiarly mark this dis- 
 ease are, an intense throbbing pain in the 
 ear and head, accompanied with symptomatic 
 fever ; and sometimes slight delirium super- 
 venes. 
 
 The pain is not always equally intense, but 
 fluctuates in degree ; and its paroxysms, or fits, 
 are somewhat like those of the tooth-ache. 
 
65 
 
 It is this resemblance to the latter that has 
 caused it too often to be neglected, or impro- 
 perly treated. It is a disease that evidently 
 requires the most active antiphlogistic treat- 
 ment ; and nothing stimulant, either in the way 
 of general and topical means, should be em- 
 ployed. Hence acrid substances, and stimu- 
 lating fluids, used under the idea of curing the 
 tooth-ache, aggravate, to a certainty, this dis- 
 ease ; and suppuration, the very circumstance 
 to be avoided, is hereby hastened. 
 
 The treatment to be observed here is obvious : 
 to arrest inflammation in the first instance, if 
 early applied to ; and if this be done with 
 energy at the first, all the symptoms will be 
 found to subside. The deafness, which is always 
 great during the inflammation, will gradually 
 lessen, and the deposited lymph, instead of 
 forming pus, will soon be absorbed. But if 
 tiie inflammation has continued for some time, 
 even though the resolution be accomplished, 
 
 N 2 
 
66 
 
 (he patient does not always recover his perfect 
 hearing ; and the question is, — how far a propel 
 secondary treatment may obviate this imperfect 
 state, which the previous inflammation has left: 
 The defect here chiefly arises from a deposition 
 of lymph, and perhaps, also, from some thick- 
 ening of the parts. 
 
 We know that, in other parts of the body, a 
 large quantity of lymph can be absorbed by 
 using the proper means for giving activity to 
 the vessels. As the deafness, after inflamma- 
 tion of the tympanum, arises from this cause, 
 the object is to prevent the lymph from becom- 
 ing organized, and any thickening of the mem- 
 brane from becoming permanent, which must 
 continue the defect. The point, therefore, 
 should be, even if suppuration is formed, to 
 make am early opening to evacuate the matter, 
 and thus prevent the membrane from acquiring 
 that state which renders it unfit for receiving 
 acutely the impression of sound. An opening 
 
67 
 
 being once made, and the matter discharged, 
 every precaution must be next taken to prevent 
 it from again forming. 
 
 But in a vast number of cases of this disease, 
 the attack is slow and insidious, so that at first 
 we are not aware of its commencement slight 
 fits of pain are felt, and relieved by a trifling 
 discharge ; these fits recur at intervals, and it 
 is not till after a long time that the puriform 
 discharge is fully confirmed. 
 
 This disease has divided the opinions of 
 practitioners : by some it is considered as only 
 trivial ; by others, as certainly dangerous ; and, 
 indeed, any one who regards its consequences 
 on the organ of hearing, must be of the latter 
 opinion. Its progress is rarely stopped, if left 
 to itself, till the organization of the tympanum 
 is destroyed, as well as its contents, or the small 
 bones ; when total deafness ensues. 
 
6S 
 
 Hence the most judicious treatment is re- 
 quired to arrest its progress ; and this treatment 
 is, at the same time, attended with no danger : 
 those, therefore, who think that no interference 
 should take place, I conceive, are highly to be 
 blamed. 
 
 They consider it rather as a salutary dis- 
 charge, which ought not to be interrupted ; but 
 the same argument applies to the healing of 
 every sore, and is a relic of the obsolete patho- 
 logy of former days. 
 
 This doctrine, however, is still held out by 
 many respectable practitioners ; but it rests on 
 no solid or just foundation : and in all cases of 
 this disease we are called upon to interfere as 
 early as possible, if we wish to preserve the 
 functions of the organ. Of this prejudice Mr. 
 Saunders, to whom we are indebted for the lirst 
 clear and judicious account of this disease, gives 
 us some strong instances. 
 
69 
 
 Even the late Dr. Heberden, in his Commen- 
 taries, had taken up this popular but mistaken 
 opinion, that it ought not to be healed. 
 
 Some of the first surgeons and anatomists, 
 also, have adopted the same idea, on the sup- 
 position that the discharge, being suppressed, 
 inflammation of the brain might be the conse- 
 quence. That, however, is more likely to hap- 
 pen from the progress of the disease passing on 
 to ulcerate the parts, and destroy the bone ; 
 which ulceration may thus spread to the dura 
 mater, one of the membranes of the brain. But 
 Nature has so provided, that as ulceration pro- 
 ceeds the membranes generally thicken, as a 
 safeguard in some measure to check its progress. 
 
 In order to convey an accurate idea of this 
 disease, it may properly be divided into three 
 stages. 
 
 The first consists of a simple puriform dis 
 
70 
 
 charge. The second, is when it is complicated 
 with fungus and polypus. And the third, is when 
 a caries of the tympanum attends the discharge. 
 
 The progress of the disease is uncertain : at 
 one time it advances rapidly through its diffe- 
 rent stages ; at another, it requires years to 
 make any considerable progress. It is evi- 
 dently not a constitutional disease, but merely 
 an affection of the part, and, as such, is only to 
 be attacked by local means; for general reme- 
 dies are of no avail. Where the constitution is 
 weakly and infirm, it may be put into a more 
 vigorous state, by the use of tonic medicines, 
 such as bark and other astringents, which will 
 certainly tend to quicken the healing of the 
 parts. But, at the same time, direct applica- 
 tions to the seat of the disease are to be consi- 
 * 
 
 dered as the true means of cure. 
 
 Blisters and setons are here, with many sur- 
 geons, favourite remedies : they may, indeed, 
 
71 
 
 act as auxiliaries, oil the principle of deriva- 
 tion ; but they ought to be judiciously used, 
 and confined to habits that can bear such a 
 drain ; for if employed indiscriminately, and 
 without attention to this circumstance, the pa- 
 tient may be subjected, for a length of time, to 
 pain and inconvenience, without in any degree 
 promoting the cure. 
 
 This disease, I have already stated, is at- 
 tended with various degrees of deafness, and 
 thus, in like manner, will the degree of recovery 
 be found to vary. The extent of deafness, 
 during the disease, is not always according to 
 the apparent injury which the tympanum seems 
 to have suffered : for in some cases the deafness 
 is trivial, where the injury of structure is appa- 
 rently great ; and in others, the deafness is com- 
 plete where injury appears to be but small. 
 
 In the first stage, the inflammation and thick- 
 ening of parts will evidently obstruct the pas- 
 
 o 
 
72 
 
 sage of sound between the external and internal 
 
 / 
 
 ear. 
 
 In the second stage, the mechanical obstruc- 
 tion of a fungus, or polypus, must still more 
 oppose the entrance of sound, and increase the 
 degree of deafness. 
 
 On the suppression of the discharge, in the 
 first or second stage, there is often a remarkable 
 increase of deafness. 
 
 Of the real state of the parts it is impossible 
 a priori to decide, as from their situation they 
 are invisible ; and it would be rash to determine 
 how far the power of nearing is to be restored, 
 or to flatter the patient with delusive expecta- 
 tions ; but, whatever the state of the case may 
 be, for the strong reasons already laid down, I 
 conceive it always proper to make an attempt 
 at a cure; the patieut cannot be injured by it, 
 and there is always a chance of doing some- 
 
73 
 
 thing in the way of relief, if the disease be not 
 advanced to its last and ultimate stage. 
 
 Where the discharge has continued, it forms 
 in part a medium for the transmission of sound ; 
 and, therefore, though offensive in the last stage, 
 the hearing will be still more diminished if 
 it be partially suppressed: thus patients in this 
 state, after syringeing their ears, hear better for 
 a time, in consequence of the fluid acting as 
 a temporary medium for the transmission of 
 sound. 
 
 Though in very old cases cures may be per- 
 formed, yet it is to recent ones chiefly that 
 the Aurist is to look for success ; but, owing 
 to popular prejudice, the malady is too often 
 slighted or temporised with ; and hence it is 
 generally in confirmed cases only that he is con- 
 sulted : for in the early period of the disease, 
 when relief may be obtained, it is commonly 
 
 neglected, till, tired out with the fruitless ex- 
 
 o 2 
 
74 
 
 pectation of nature curing herself, the patient 
 has at last recourse to advice. 
 
 No complaint, perhaps, requires greater at- 
 tention in training it through its different 
 stages, and in varying the treatment of the dis- 
 ease according to these stages. No one remedy 
 is to be trusted to ; but the circumstance of 
 each individual case should be studied before 
 any particular method is adopted. 
 
 The first stage of the disease will often yield 
 to an injection of the zinci sulphas, or sulphate 
 of zinc, used night and morning, which will 
 often effect a cure in the space of three weeks 
 or a month. It is apt, however, to leave a 
 morbid sensibility of the ear, which occasions 
 pain on the entrance of loud sounds. The 
 plumbi superacetas, or sugar of lead, is equally 
 useful as an injection. 
 
 In some cases the continuance of these injec- 
 
75 
 
 lions has been necessary for a considerable 
 time ; which it may be proper to state in order : 
 first, that the patient may not look for a speedy 
 cure ; and, secondly, that he may be induced to 
 persevere a reasonable length of time. 
 
 In the second stage of the disease, the point 
 is to extract the fungus, or polypus, with a pair 
 of small forceps ; and, if these excrescences do 
 not come entirely away, to endeavour to pinch 
 the roots till the whole is removed. The roots 
 may then be touched with the argentum nitra- 
 tum, as before mentioned. 
 
 On the removal of the fungus, or polypus, the 
 injection of zinc is to be used ; and in a great 
 number of cases the hearing will be restored, 
 and the discharge suppressed. 
 
 When the fungus, or polypus, is removed, the 
 morbid state is then reduced to the same as I 
 mentioned in the first stage. 
 
76 
 
 In all cases of this disease where a cure is 
 completed, the healing process seems to be 
 effected by the extension of the cutis, or skin 
 of the meatus, into the tympanum, and its 
 becoming continuous with the membraneous 
 lining. 
 
 This fact is confirmed by dissection in several 
 cases of the disease, where such a continuation 
 clearly appeared. 
 
 After a cure, as a free passage of the air takes 
 place, it occasions a drying of the thinner or 
 watery parts of the discharge; the remainder 
 accordingly becomes inspissated, and is the 
 cause of occasional increase of deafness : but 
 though this be the case, if a practitioner, w hen 
 consulted, ascertains that there has been a pre- 
 vious discharge, he should be extremely cautious 
 of employing any forcible means to remove if, 
 lest he should endanger the re-production of 
 the former disease. 
 
77 
 
 II. Obstruction of the Eustachian Tube , requiring 
 perforation of the Tympanum. 
 
 From its puriform discharge, the next affec- 
 tion of the tympanum I have to consider, is the 
 influence produced on it by the obstruction of 
 the Eustachian tube. 
 
 By this obstruction a very great degree of 
 deafness is produced, and air can no longer be 
 admitted into the cavity of the tympanum, 
 while the included portion of air is either ab- 
 sorbed or else it remains. 
 
 If it remain, it becomes condensed, and coun- 
 terbalances the pulses of air excited by sound- 
 ing bodies ; if it be absorbed, the membrane of 
 the tympanum is carried by the pressure of the 
 atmosphere as far as its limits can go, and in 
 this case cannot vibrate, as it ought, to any 
 considerable degree. That this last opinion is 
 the most just, is confirmed by dissection, which 
 
78 
 
 has shown the tympanum in a number of cases 
 filled entirely with mucus, and consequently, 
 that the air had been absorbed. 
 
 The cause of the obstruction of the Eusta- 
 chian tube, as before stated, is either syphilitic 
 ulcers, or sloughing from the cynanche maligna, 
 or putrid sore-throat. 
 
 It is on the healing of the ulcers that deaf- 
 ness ensues; for then the obstruction becomes 
 complete, and the opening into the throat is as 
 it were sealed up : besides these causes, a poly- 
 pus, or one depending from the pharynx, has 
 occasionally produced the same obstruction ; 
 and an enlargement of the tonsils, where it 
 Continues, as in some cases, permanent, has 
 been attended with the same effect. 
 
 This species of deafness is attended with no 
 peculiar or diagnostic symptom to mark it, 
 except the actual loss of hearing. There are 
 
79 
 
 neither distressing noises in the ear, nor any of 
 those other sensations which indicate a diseased 
 state of the auditory nerve, or certain morbid 
 causes acting upon it. 
 
 The true criterion to distinguish this is, that 
 some conspicuous disease of the throat always 
 precedes it ; and, therefore, the previous history 
 from the patient is of great consequence in 
 ascertaining it. 
 
 On examining the parts in this case by 
 dissection, I have found that the obstruction 
 lies in the cartilaginous extremity of the tube. 
 There are instances, however, where the ob- 
 struction depends on an increasing or super- 
 abundant ossification, filling up the substance 
 of the bone. 
 
 In such cases the disease is slow in its pro- 
 gress, different from the former, and at the same 
 time shows no obvious cause. 
 
 p 
 
so 
 
 I hough this species of deafness is highly 
 formidable, jet the cure of it has been in many 
 instances accomplished, by means of an opera- 
 tion first suggested, and successfully performed 
 by Mr. Astley Cooper : to this he was naturally 
 led by the important observation, that the sense 
 of hearing, though imperfect, is not destroyed 
 in cases of suppuration of the tympanum, or 
 its partial injury from other causes; hence, as 
 deafness is complete from obstruction of the 
 tube, from no entrance being given to the air, 
 lie very rationally supposed that, by making a 
 small puncture in the membrane, in order to 
 allow the air to get access, the machinery of the 
 ear would thus be set in motion. 
 
 The experiment confirmed the justice of the 
 idea ; and hearing has been preserved in a 
 number of instances in this way, not only by 
 Mr. Cooper, but by myself and others. 
 
 The operation is performed by simply passing 
 
81 
 
 the instrument into the meatus, and pushing 
 it through the anterior and inferior part of the 
 membrane of the tympanum, for in this posi- 
 tion the manubrium of the malleus will be 
 avoided ; a circumstance particularly to be 
 attended to, in order that no part of the ma- 
 chinery may be injured. 
 
 Immediately on making the perforation a 
 little crack will be heard by the patient, like 
 the tearing of parchment, from the rapid en- 
 trance of air through this narrow aperture. In 
 directing the instrument, care should be taken 
 that it does not penetrate the vascular part of 
 the membrane so as to occasion an effusion of 
 blood ; otherwise the success of the operation 
 may be defeated. 
 
 When the operation is properly performed, 
 hearing is instantaneously restored : by the per- 
 foration a new substitute is made in the small 
 aperture for the Eustachian tube, and the air 
 
 p 2 
 
82 
 
 being thus admitted into the tympanum, the 
 action of the membrane, and of all the con- 
 necting machinery, is in a certain degree re- 
 established. 
 
 Some surgeons have performed the operation 
 with a common probe. 
 
 In such cases the only danger of a relapse is 
 from a closing of the puncture : to avoid this, a 
 larger perforation may be made ; but then in 
 proportion is the membrane of the tympanum 
 diminished, and consequently the acuteness of 
 the sense of hearing lessened. 
 
 The small opening, therefore, is to be pre- 
 ferred, even should a re-union take place. When 
 this happens, it is generally three or four days 
 after the operation, though sometimes I have 
 seen it later. 
 
 The most favourable circumstance is when 
 
83 
 
 the sides become fistulous, for then the sense of 
 hearing is certainly saved. 
 
 When re-union takes place, the operation 
 requires to be repeated, and there is no danger 
 attending it. In one patient, Mr. Saunders 
 performed it three successive times in a very 
 short period ; and then, not wishing to have 
 occasion to repeat it, he made a sort of lacera- 
 tion, which was successful in preserving the 
 opening ; but the degree of hearing, he acknow- 
 ledged, was lessened by this enlargement. 
 
CHAP. IV. 
 
 Diseases of the Internal Ear. 
 
 The diseases of the Labyrinth, or Internal 
 Ear, may be divided into the constitutional or 
 local, or such as influence it from a morbid con- 
 dition of the brain, and such as arise from a 
 change in its whole structure. 
 
 I. Constitutional. 
 
 Of all the causes of deafness, that which pro- 
 ceeds from an organic affection of the brain is, 
 of course, the most dangerous. In apoplectic 
 cases, with faultering of .speech and blindness, 
 
85 
 
 we find deafness also produced by the general 
 affection of the head. But worst of all is the 
 case where a tumour of the brain compresses 
 the origin of the nerves ; for here the' deafness 
 is complete, and no impression can be conveyed 
 through the organ to the mind. 
 
 A tumour, however, in the vicinity of the 
 organ of hearing, though it runs its course, and 
 proves fatal in the end, has rather a contrary 
 effect ; and even while the pupils are dilated, 
 and there is every appearance of pressure on 
 the brainy a morbid acuteness takes place, in 
 consequence of the surrounding inflammation. 
 Indeed, the auditory nerve often becomes 
 acutely sensible in disease, or the patient 
 suffers from acuteness of perception, or has a 
 tinnitus auriurn , or singing of the ears, analo- 
 gous to the flashes of light which sometimes 
 affect the eyes in total blindness, and which 
 those experience who are blind of cataract. 
 
86 
 
 So morbidly acute does sensation become 
 in some persons under disease, that the least 
 motion of the head will excite a feeling like the 
 ringing of a great bell close to the ear. 
 
 In delirium also, in vertigo, in apoplexy, and 
 in hysteria, the increased sensibility of the 
 organ becomes a painful sensation. In para- 
 lytic affections of the face, we find there is 
 deafness in the corresponding ear, if the affec- 
 tion of the nerve be near the brain ; which is 
 explained by the intimate connexion between 
 the auditory nerve and the communicating one 
 of the face. From observing the course of the 
 latter nerve through the temporal bone, and its 
 connexion in the tympanum, we know why, 
 in violent tooth-ache, and in tic douloureux , we 
 find the Eustachian tube and root of the tongue 
 affected . 
 
 The ear is also sometimes affected by sym- 
 pathy, from foulness of stomach and bowels ; 
 
87 
 
 and the same reason may be assigned for the 
 symptom of hypochondriasis — that they are 
 affected with strange sounds, and in the case 
 of intestinal worms, we find murmuring and 
 ringing of the ears a symptom. 
 
 Of the organic diseases of the ear there is 
 little to be found on record. It would seem, at 
 times, that the fluids become so altered in their 
 consistence as to prove an absolute destruction 
 of the organ, and frequently a cause of deaf- 
 ness : the whole internal ear has been found at 
 times filled with a substance like cheese. 
 
 A disease also of the auditory nerve, like 
 that of the retina, or optic nerve, in the gutta 
 serena, is no unfrequent complaint ; and in 
 several cases lately, I have treated it as amau- 
 rosis, with considerable success. 
 
 Deafness in acute fever is considered a favour- 
 able sign ; as it argues, according to the old 
 
 Q 
 
88 
 
 theory, a metastasis or translation of the mor- 
 bific matter ; or rather, according to modern 
 opinion, it shews a diminution of morbid sensi - 
 bility of the brain. The accumulation of the 
 vessels of the brain, or of those surrounding the 
 auditory nerve, will also produce deafness, and 
 unusual sensations of the ear. This we find 
 instanced in suppression of the menses, and in 
 haemorrhoids, surfeits, &c. ; in which cases it is 
 found preceded by vertigo and head-ache. 
 
 In comparing the diseases of the ear and the 
 eye, we find a considerable analogy subsisting 
 between them ; but in those of the eye there is 
 one advantage, that the transparency of its 
 humours is a leading mark to direct us, which 
 we do not possess in the case of the ear : but in 
 judging of the diseases of the internal ear, we 
 should always endeavour to determine, whether 
 it is in the seat of sense or in the brain that the 
 real affection lies ; otherwise our attempts to 
 relieve will be ineffectual. 
 
89 
 
 II. Local . 
 
 From the constitutional diseases of the inter- 
 nal ear 1 next proceed to examine the local ; 
 and, however varied the change of structure 
 on which they may depend, they have all been 
 comprehended and treated under the vague, 
 and, perhaps, too general term of nervous 
 deafness. 
 
 The general symptoms by which this species 
 of deafness is distinguished are, various kinds 
 of noises affecting the head, and communicated 
 from the seat of the organ. 
 
 At times, th^se noises seem somewhat to 
 resemble the murmuring of water ; at other 
 times, they may be compared to the hissing of 
 a tea-kettle as it boils over : on other occasions, 
 they are represented by the patient as like the 
 rustling of leaves, the blowing of wind, &c. : 
 all these noises are to be considered as false 
 
90 
 
 perceptions in the organ, not arising in the 
 nerve itself, but in the condition of the parts 
 about it. 
 
 There is a particular species of this deafness 
 which represents a beating noise, like a pulse ; 
 this noise is much increased by any bodily 
 exertion occasioning an increased action of the 
 heart. The cause of this species clearly depends 
 on an irritation of the arterial system ; but 
 whether depending on the small arteries of the 
 labyrinth, or on the internal carotid artery, 
 which passes close beneath the cochlea, is un- 
 certain ; but whichever of these may be the 
 cause, it gives rise to the same false perceptions 
 as in the other species. 
 
 All species then of nervous deafness may be 
 considered as peculiar modifications of consti- 
 tutional disease, affecting the nervous system in 
 general, and connected with that state which 
 constitutes the hypochondriac and hysterial 
 
 1 
 
91 
 
 habit. The general morbid disposition is here 
 extended to a particular sense, and by viewing it 
 in this light the change of the constitutional af- 
 fection must form the basis of the cure. It is by- 
 considering it in this just point of view that 
 proper principles of treatment can only be 
 adopted, and that much may be done to remove 
 this species of the complaint. The hysterial 
 spasm of the throat and primae viae becomes 
 naturally, from the connexion and sympathy of 
 nerves communicated to those of the ear, and 
 deafness in most cases is a never failing symp- 
 tom with hysterical patients. In the same man- 
 ner that torpor of the stomach and primae viae, 
 so characteristic of hypochondriasis, occasions a 
 dull sensation and torpor of the auditory nerve, 
 and produces that noise and confused impres- 
 sion so often complained of in hypochondriasis. 
 
 A wide field, therefore, opens here for new 
 principles of treatment, by attacking the con- 
 stitutional cause, and that much relief may be 
 
92 
 
 obtained by the application of constitutional 
 means, experience daily evinces. It is from 
 not keeping that analogy in view that nervous 
 deafness is so formidable to most surgeons. 
 
 In all cases of this nervous deafness, when it 
 affects one ear, I may observe, it is in general 
 rendered worse by the conduct of the patient 
 himself ; for when the organ of one side is 
 injured, we hear so much better with the other, 
 that we only attend to the sensation conveyed 
 by it, and neglect the duller sensation. The 
 effect of this is, that the diseased ear becomes 
 worse, and the same consequence arises as that 
 which takes place in the eyes by squinting. 
 
 In attending to the treatment of nervous 
 deafness, if the practitioner is early applied to, 
 and the disease is still in its first stage, it may 
 be considered in general as curable ; and even 
 cases of long standing, when properly treated, 
 admit of considerable relief. 
 
93 
 
 In entering upon the treatment of nervous 
 deafness, it is essential to observe, that a great 
 similarity exists between it and that species 
 which arises from a syphilitic cause. In ner- 
 vous deafness, therefore, it is proper to inquire 
 minutely into the history of the case, and to 
 ascertain from what source the disease origi- 
 nates. 
 
 Several cases of nervous deafness, proceeding 
 from the latter cause, have come under my 
 care, which yielded to a regular course of 
 mercury, and the function of the organ was in 
 all completely restored. 
 
 Again, where the connexion of the disease 
 with the above cause is not so clear, instead of 
 the treatment prescribed, a strict antiphlogistic 
 course, if the patient be able to bear it, will 
 often prove successful ; namely, powerful saline 
 cathartics, of which the best is the vitriolated 
 magnesia : the doses should be repeated as 
 
94 
 
 often as the strength of the patient will admit ; 
 and in the intermediate time small doses of 
 the subnmriate of mercury are to be adminis- 
 tered, to promote absorption, by taking off any 
 thickening of the parts, which is apt to impede 
 the due performance of the functions of the 
 organ. 
 
 This practice will in incipient cases succeed : 
 and, if not completely, will at least palliate 
 the predominant symptom ; and in all cases 
 it ought to have a fair trial, for deafness should 
 never a priori be considered as incurable. 
 
 At the same time, it must be confessed that 
 the diseases of the internal ear are involved in 
 much obscurity. Dissections have proved that 
 a total deafness may exist without any apparent 
 defect in the mechanism, either of the external 
 or internal ear. 
 
 This has been shown by the dissection of 
 
95 
 
 several cases of persons who had been deaf 
 during life. On examination of these cases, 
 every part appeared perfect ; even the nerve 
 and its expansion showed no trace of morbid 
 change ; and the alteration, whatever it was, 
 was too minute for either the knife or the eye 
 to detect : it consisted, perhaps, in an original 
 want of power in the nerve to receive impres- 
 sions. This is equally another proof of its con- 
 nection with hysteria and hypochondriasis, 
 where the nervous system is in part affected, as 
 is too often observable. 
 
 But though I have stated that nervous deaf- 
 ness in its first stage is generally curable, much 
 will depend on the time the treatment is con- 
 tinued, and on the perseverance of the patient 
 and the practitioner. 
 
 In some instances a cure has been accom- 
 plished in a very short period ; in others I have 
 
 R 
 
96 
 
 found it necessary to persevere for a consider- 
 able time, and recovery at last has taken place. 
 
 With respect to the application of topical 
 remedies to the ear, gentle stimulants, in form 
 of liniment, as a portion of the essential oils 
 mixed with the oil of almonds, may be benefi- 
 cially introduced into the ear, where, being 
 retained, they will serve as a substitute for the 
 natural secretion, and at the same time increase 
 the sensibility of the passage. 
 
 All the advertised nostrums are preparations 
 of this kind ; and, so far as they supply the 
 secretion, and gently stimulate the passage, in 
 some cases they may be useful : but as to the 
 notion that they are to remove an organic 
 affection of the part, the various species of 
 which I have described, it only shows the com- 
 plete ignorance of those who expect success 
 from such inadequate means of relief. 
 
97 
 
 As I have stated, that there is so little to be 
 done by medicine in confirmed cases of deaf- 
 ness of long standing, arising from imperfect 
 organization of the ear, I have with much pains 
 collected a variety of contrivances to assist 
 hearing, many of which I have obtained from 
 the Continent, in order to give all possible 
 relief in such distressing cases. 
 
 The newest inventions of this kind, are the 
 artificial ears lately introduced into this coun- 
 try from France, where they were originally 
 manufactured. 
 
 By being closely adapted to the ear, they 
 increase the collection of sound ; but besides 
 that, there is an additional force wanted to 
 transmit it through the passage. In this re- 
 spect, the French invention is deficient : to 
 remedy its defect, I have added a small tube, 
 which, by contracting the passage, will occasion 
 
 the sound to enter with greater impetus. This 
 
 R 2 
 
98 
 
 invention is found very convenient, in conse- 
 quence of the substitutes being applied over the 
 natural ear, which they are made to resemble. 
 
 The Spanish ears also, made of shells, answer 
 very well : but, at the same time, I must re- 
 mark, that these mechanical contrivances, al- 
 though found to be more serviceable than any 
 thing of the kind in general use, yet do not 
 apply with equal success in all cases ; and there 
 are, in fact, cases in which no mechanical con- 
 trivance can be of use. 
 
 With some patients the German silver ears 
 answer better than any others ; but are ob- 
 jected to by many, on account of their weight, 
 and being more conspicuous than the French 
 ears ; it also being necessary that they should 
 be fixed by a spring, which goes over the head. 
 
 The French ears, being made of a light sub- 
 
99 
 
 stance, where they answer the purpose, are 
 generally preferred. 
 
 I have also invented a hearing-trumpet, form- 
 ing a parabolic conoid, on the same principle 
 as the speaking-trumpet used at sea, which is 
 so well known to answer the purpose in ex- 
 tending the impression of sound. It has this 
 convenience, that it shuts up in a small case for 
 the pocket. 
 
CONCLUSION. 
 
 1 have thus traced, in the preceding pages, 
 the various diseases of the Ear, and laid down 
 the general principles of cure, best adapted 
 to each : but it is to be observed, with regret, 
 that few attempts have yet been made by 
 anatomists to trace the morbid changes or 
 affections to which the ear is liable. On this 
 subject we are almost destitute of information, 
 while the diseased appearances of all the other 
 organs of the body have been traced w ith great 
 minuteness and attention, have been accurately 
 examined and ascertained, and the symptoms 
 which accompany them recorded with precision 
 and care. 
 
101 
 
 But here, it must he confessed, there are 
 many and great difficulties to obstruct our in- 
 quiries ; indeed, some of them would appear at 
 first sight almost insurmountable. Nature, as 
 we have seen, has placed the chief and most 
 important part of the ear, in the living subject, 
 beyond the reach of our examination; while, 
 its diseases being rarely mortal, the ears are 
 seldom dissected in ascertaining the causes of 
 death. 
 
 The few, therefore, who have applied them- 
 selves to the subject of the elucidation of the 
 
 i 
 
 morbid structure of the ear, have been obliged 
 to dissect such ears as came by chance in 
 their way, without knowing any thing of the 
 previous history of the person to w hom they 
 belonged, or the symptoms under which he 
 laboured. 
 
 Thus, even though dissection may show the 
 various morbid changes of the structure, the 
 
102 
 
 assistance of anatomy is still highly imperfect, 
 in so far as these changes are not accompanied 
 with a knowledge of the symptoms which dis- 
 tinguished them during the life of the patient. 
 
 To the above difficulty, a further one may be 
 added, peculiar to this class of diseases, namely, 
 that a clear and distinct account of the feelings 
 can scarcely be expected from a deaf person, 
 and is seldom obtained. 
 
 Though conscious of their imperfection, such 
 persons are not aware of the numerous causes 
 from which they may arise. The approach of 
 deafness, also, is often slow and imperceptible, 
 and unattended with pain, or other strong 
 sensation, to mark its commencement. 
 
 Hence few strong impressions are made by it 
 on the mind of the patient for a time, to 
 awaken him to the approaching infirmity ; and 
 lie loses the faculty of the organ so iinper- 
 
103 
 
 ceptibly, that his friends often perceive it 
 before he does himself. 
 
 It is from these difficulties, which have been 
 met with by surgeons and anatomists in their 
 attempts, that the subject of the ear has been 
 so much neglected. But I am inclined to think, 
 that the constant dissection of diseased ears, 
 accompanied by due zeal and attentive research, 
 will lead to much useful information; and com- 
 paring the symptoms observable during the 
 patient's life, as often as that can be done, with 
 the appearances of the ear on dissection, will 
 enable us to trace cause and effect ; and by so 
 doing, adequate means of relief will often come 
 to be discovered. 
 
 But though our knowledge may be thus en- 
 larged in respect to the history and appearances 
 of the diseases of the ear, we shall, perhaps, be 
 often disappointed of success in attempting a 
 
 cure. This cannot be otherwise, when we 
 
 s 
 
104 
 
 reflect, that of the diseases of the ear, one-third 
 is confined to the labyrinth, or internal ear ; 
 and as this part is totally inaccessible, no 
 manual assistance can be rendered. 
 
 But though the aid of surgery is thus pre- 
 cluded, other secondary means may still be 
 resorted to. Internal remedies are capable of 
 producing changes of a salutary nature, in a 
 great number of local diseases, particularly in 
 those organic affections, whose nature is known 
 and discriminated. 
 
 The diseases of the ear, as I before observed, 
 are often constitutional ; and the general treat- 
 ment of the constitution will therefore in- 
 fluence the malady of the particular part. Thus 
 syphilis, in its constitutional form and ultimate 
 stage, attacks the ear, and deafness is produced 
 by this specific cause. 
 
 The same course of medicines that remove 
 
105 
 
 the other constitutional symptoms, has an equal 
 effect on this organ ; and if there are no other 
 constitutional symptoms but deafness, then em- 
 ploying internal medicines, according to the 
 regular method observed in the treatment of 
 this disease, will remove the complaint. 
 
 Deafness is often the attendant of a cold, 
 or inflammatory state of habit ; in this state, 
 purging, or aperient remedies, properly admi- 
 nistered, will be successful. 
 
 Various other instances might be adduced, 
 all tending to shew that there are different 
 morbid changes of this organ, as well as of the 
 others, which are curable by a general treat- 
 ment acting upon the constitution, and thus 
 indirectly affecting the part. 
 
 Nay, even the most difficult of the whole of 
 
 this class of diseases, that which is termed 
 
 s 2 
 
106 
 
 nervous deafness , may, as we find in its first 
 stage, be arrested in its progress, and thus ren- 
 dered curable, if the proper analogy between it 
 and other nervous diseases depending on consti- 
 tutional habit be kept in view. 
 
 And it may be considered, that while, on the 
 one hand, there are many and great difficulties, 
 which present themselves in the prosecution of 
 our subject, on the other hand, there are some 
 advantages to counterbalance these, and to 
 prompt us forward in our exertions. 
 
 In concluding the present Work, therefore, 
 I must again be allowed to urge, that though 
 much may be done to give relief in diseases 
 of the ear, much still remains to be learned 
 in this branch of practice. 
 
 As a leading step to this, and that theory and 
 practice may go hand in hand, I have succeed- 
 ed, with the assistance and patronage of some 
 
107 
 
 of the first persons in rank, science, and pro- 
 fessional celebrity, in instituting a Public Dis- 
 pensary for the Diseases of the Ear; where 
 considerable numbers have been cured, and 
 where pupils have the fullest opportunities of 
 examining the different diseases of the organ, 
 of marking the success of their treatment, and 
 of judging of the issue of any new plans that 
 may be proposed, either by myself, or from the 
 suggestion of others ; several eminent profes- 
 sional characters having kindly offered their 
 assistance at the Dispensary. 
 
 From the success which has attended my ex- 
 ertions in this neglected branch of practice, 
 others have been induced to direct their atten- 
 tion to it, and it is to be hoped that such ex- 
 tended investigation of the subject will, in a 
 few years, place it in the same improved state 
 as the other branches of medicine and surgery; 
 for, in my opinion, had the late Mr. Saunders, 
 
108 
 
 whose modes of practice I highly approve and 
 am endeavouring to follow up, confined himself 
 to the exclusive treatment of the ear, instead of 
 the different branches of surgery, the result of 
 his labours would have been of the highest 
 benefit to society at large. 
 
CASES 
 
 CASE I. 
 
 Mrs. W. applied to me, under a violent in- 
 flammation of both ears, attended with much 
 pain and fever. 
 
 After taking a few ounces of blood from the 
 vicinity of the parts, and applying warm 
 fomentations, the symptoms gradually subsided. 
 It may be remarked, that her hearing was not 
 much effected, although she could not hear 
 sounds distinctl} 7 . By the use of laxative me- 
 dicines, at the same time adopting an antiphlo- 
 gistic plan, she is now perfectly recovered. 
 
110 
 
 CASE. II. 
 
 Miss B. applied to me with an herpetic erup- 
 tion of both ears, which she had been subject 
 to at different times for the last five years. By 
 taking the Compound Calomel Pill regularly 
 every night, for about a month, and anointing 
 the external part of the ear with an ointment 
 made of equal parts of the Nitrated Mercurial 
 Ointment and Hog’s Lard, she is now perfectly 
 well. It was, however, necessary to order her 
 an astringent injection, which was continued 
 for the space of ten days. 
 
 CASE III. 
 
 Miss L. complained of an ulcer which co- 
 vered the whole of her left ear. It was not 
 attended with a puriform discharge from the 
 tympanum ; but merely the external part was 
 diseased. As the ulcer had been of long stand- 
 
Ill 
 
 ing, I was fearful that she would lose her ear, 
 as she appeared of a scrofulous habit. After 
 continuing the use of an alterative medicine 
 for near a month, and applying the Ointment 
 of Zinc to the parts affected night and morn- 
 ing, they began to put on a better appearance. 
 But in order to hasten the cure, 1 found it 
 necessary to substitute the Nitrated Mercurial 
 Ointment, mixed with Hog’s Lard; which, in 
 the course of a month from her first applica- 
 tion, completely restored her. 
 
 The ulcer, however, left a slight scar ; but 
 was not very observable. 
 
 CASE IV. 
 
 Mr. C. applied to me with a puriform dis- 
 charge from the tympanum, which had conti- 
 nued for some time. As it was in its first stage, 
 it yielded to a single astringent injection of the 
 Sulphate of Zinc. 
 
 T 
 
112 
 
 CASE V. 
 
 Col. W. applied to me in consequence of a 
 puriform discharge of the tympanum. On 
 inspecting the tympanum, 1 found it injured; 
 as air could be blown out of the meatus. By 
 observing a strict antiphlogistic regimen, using 
 an injection of the Sulphate of Zinc, and taking 
 an alterative for six weeks, the discharge was 
 suppressed, and the hearing restored. 
 
 CASE VI. 
 
 Mrs. N. applied to me in consequence of a 
 large polypus which came out of the meatus. 
 It appeared after a puriform discharge from the 
 tympanum. For some time air had passed out 
 of the meatus, on blowing the nose : this symp- 
 tom had ceased about the time the excrescence 
 was first observed. I succeeded in extracting 
 
113 
 
 the polypus, which came out entire. After 
 dressing for a short time with the Red Nitrated 
 Mercurial Ointment, the parts to which the 
 polypus adhered healed. I conceived it neces- 
 sary to adopt the alterative and purgative plan, 
 which was carried on for about a month ; at the 
 expiration of which time she was quite well. 
 
 CASE VII. 
 
 Miss W. was sent to me with a polypus in 
 her left ear, attended with a puriform discharge 
 from the tympanum; which had impeded her 
 hearing so much, that her friends took her from 
 school. On inquiry I learned, that she had 
 had the discharge for some time. I extracted 
 the polypus with a pair of small forceps ; but 
 was not able to bring it away entire. I after- 
 wards pinched the roots, and applied the Ar- 
 gentum Nitratum, as recommended by Mr. 
 Saunders. 
 
 T 2 
 
114 
 
 I found it necessary to order an astringent 
 injection, which, being used for some little 
 time, succeeded in suppressing the discharge. 
 As she was a girl of a delicate constitution, 
 I administered the Bark, joined with a chaly- 
 beate. Her hearing is not only restored, but 
 her general health also considerably improved. 
 
 CASE VIII. 
 
 Mr. L. had been subject to a puriform dis- 
 charge from both ears, which had troubled him, 
 more or less, for several years. The discharge, 
 when he first applied to me, was very consider- 
 able, and was extremely offensive ; it was occa- 
 sionally mixed with blood ; and such was its 
 acrimony, that the ear and neck were exco- 
 riated by it. 
 
 Observing my usual plan of not stopping the 
 discharge hastily by the use of astringent injee- 
 
115 
 
 tions, for fear of producing an inflammation of 
 the brain, a caution necessary to be attended 
 to in the treatment of diseases of this nature, 
 I prescribed, for some few weeks, small doses 
 of the Submuriate of Mercury, and twice a 
 week some purgative medicine. After follow- 
 ing this plan for about ten days, and having 
 blisters applied behind the ears, I ordered him 
 an injection of the Nitrated Silver, which he 
 used night and morning for a month ; at the 
 expiration of which time the discharge was 
 suppressed, and the hearing restored. 
 
 CASE IX. 
 
 Mr. D., aged thirty-two, had been deaf of 
 the left ear from his childhood. On inspection, 
 I found it perfectly sound. The fault evidently 
 lay in a deficiency of the natural secretion : by 
 restoring this, by means of proper applications, 
 and by observing for some little time a strict 
 
116 
 
 phlogistic regimen, so perfectly has his hearing- 
 been restored, that he can hear the tick of a 
 watch at the distance of four yards ; which 
 before he could not do unless held in direct 
 contact with the ear. 
 
 CASE X. 
 
 Peter Oliver was recommended as a pa- 
 tient to the Royal Dispensary. He had been 
 deaf nearly four years when he was admitted. 
 As 1 found it was a nervous affection, I applied 
 blisters behind both ears, put him on an anti- 
 phlogistic plan, gave him small doses of Sub- 
 muriate of Mercury, and occasionally a brisk 
 dose of the Vitriolated Magnesia. In the space 
 of live weeks he was perfectly well. 
 
117 
 
 CASE XI'. 
 
 David Voir, a lad nine years of age, was 
 admitted a patient of the Royal Dispensary on 
 the 21st of March, 1817. He was a very delicate 
 boy, and laboured under great difficulty of 
 hearing. 1 treated this case in a similar man- 
 ner to the former. The blisters behind his ears 
 were kept open for a fortnight, and it was ten 
 days before he found any considerable relief. 
 He continued the use of the alterative and 
 cathartic medicines for some time; which, 
 although they relieved his hearing, reduced 
 him more than I wished. I put him on a 
 strengthening diet, and administered the Bark 
 in small doses. He has now perfectly reco- 
 vered his strength, together with his hearing, 
 and is altogether much better in his health than 
 formerly. 
 
118 
 
 CASE XII. 
 
 George Dawson, aged twenty-two years, 
 was admitted a patient for an obstinate nervous 
 deafness, at the Royal Dispensary on the 
 28th of March. On inquiry, 1 found he had 
 been deaf several years ; and upon inspection, I 
 found his ears quite dry, wanting the natural 
 secretion : he complained of the noises in his 
 head, frequently attending nervous deafness, 
 which at times prevented him from following 
 his employment. As he was a robust man, and 
 of a plethoric habit, and was very desirous of 
 obtaining his hearing, I took twelve ounces of 
 blood from his arm, put a seton in the nape of 
 his neck, and applied a blister behind each ear. 
 which were kept open for a fortnight : he took 
 five grains of the Submuriate of Mercury every 
 night, and an ounce and a half of the Sulphate 
 of Magnesia, twice a week ; at the same time 
 adopting a strict antiphlogistic regimen. He 
 persevered in the use of his medicines fora short 
 
119 
 
 time. As lie was reduced, I ordered him the 
 Bark. He was discharged on the 6th of May. 
 I have seen him since the seton has healed, 
 which it had not when he was discharged. He 
 continues quite well, having his perfect hearing, 
 and is not troubled with any noise whatever in 
 his head. 
 
 CASE XIII. 
 
 Mr. applied to me ; his case was similar 
 
 to the preceding one. I pursued the same 
 plan, only in a milder degree. The blisters 
 w ere applied ; and not having the desired effect, 
 I had recourse to the seton, which was kept 
 open a month. The parts are now healed, and 
 his hearing is perfectly restored. 
 
 CASE XIV. 
 
 Mr. N., a gentleman resident in Ireland, 
 
 wrote to me respecting his case ; which, from 
 
 u 
 
1-20 
 
 what I could learn, appeared to be a nervous 
 affection ; for, besides being very deaf, his head 
 was much affected with strange noises, which 
 at times made him melancholy. 
 
 1 prescribed nearly the same mode of treat- 
 ment as in the preceding case, at the same time 
 ordering him to lose six ounces of blood from 
 the nape of the neck, in case the medicine and 
 antiphlogistic plan did not relieve him. I 
 heard from him a short time since, to the 
 purport that his hearing is much improved, 
 and the noise in his head considerably abated. 
 
 His brother has since called on me, to ac- 
 quaint me he is now quite well. 
 
 CASE XV. 
 
 Capt. D. applied to me with a considerable 
 polypus of the left ear, which had troubled him 
 
121 
 
 for several years : it was attended with a profuse 
 discharge. As he had a great dislike to any 
 operation, I had recourse to the ligature, as re- 
 commended in a former part of this work, and 
 by passing the ligature with a probe to the 
 bottom of the fungus, I succeeded in tying it, 
 thereby stopping the circulation of the vessels. 
 In a short time the polypus came entirely away, 
 but as there was still a discharge, I had recourse 
 to an injection of the Sulphate of Copper, 
 which suppressed the discharge, and his hearing 
 is most completely restored. 
 
 CASE XVL 
 
 Amelia Stubbs, aged eighteen years, had 
 been troubled with an obstinate nervous deaf- 
 ness for twelve years, without having obtained 
 any relief. She applied at the Royal Dis- 
 pensary on the 22d of September, and in 
 
 about six weeks was discharged perfectly cured, 
 
 u 2 
 
122 
 
 by the method I have so repeatedly laid down, 
 and so successfully adopted. 
 
 CASE XVII. 
 
 William Hill was admitted a patient at the 
 Royal Dispensary on the 12th of June. His 
 case is rather singular, having been born in the 
 open air, as his mother was passing a common 
 in coming from an entertainment. He informed 
 me he had been deaf from his birth. By the 
 usual means employed, he has perfectly ob- 
 tained his hearing. 
 
 \ 
 
 CASE XVIII. 
 
 Sarah Green, five years of age, was brought 
 by her mother to the Royal Dispensary on 
 the 3d day of May. The child appeared very 
 deaf, and of a listless aspect ; by her mother’s 
 account she passed restless nights, gnashed 
 her teeth during sleep ; appetite various, at one 
 
323 
 
 time indifferent, at another voracious. The 
 child's appearance was sickly, the eye languid 
 and heavy, countenance pale, and the upper 
 lip somewhat tumified ; the bowels were irre- 
 gular, and the stools dark and offensive. 
 
 Suspecting from the deranged state of the 
 digestive functions, that the deafness might be 
 sympathetic of this affection, I felt inclined to 
 try the effect of gentle emetics, repeated twice 
 a week, with doses of calomel intervening. 1 
 shortly had the satisfaction to find the stools 
 become less foetid, the appetite more natural, 
 and the general health and appearance of the 
 child to improve; as these changes for the better 
 took place, a corresponding alteration in the 
 local affection of the ear accompanied these 
 salutary and flattering changes in the constitu- 
 tion. In short, with a restoration to good health, 
 there was also a complete recovery of the sense 
 of hearing. No worms were observed to pass 
 by stool, and the child remains perfectly well. 
 
3 24 
 
 CASE XIX. 
 
 In about a week after the last case was dis- 
 missed cured, Master Macnamara, a fine boy, 
 about nine years of age, was brought to my 
 house, labouring under similar symptoms. From 
 the efficacy of emetics in the case of Sarah 
 Green I had recourse to them in this ; and with- 
 out detailing the symptoms at length, and the 
 progressive and simultaneous disappearance of 
 the disorder of the system and the sympathetic 
 affection of the ear, suffice it that their use ap- 
 peared equally appropriate, and their effect was 
 equally beneficial. 
 
 CASE XX. 
 
 Master , the son of a worthy Baronet, 
 
 was exceedingly deaf when brought to me. He 
 too was of a pale complexion and languid ap- 
 pearance, ground his teeth when asleep, and 
 
125 
 
 often when awake picked his nose ; his bowels 
 and appetite were irregular, stools foetid and 
 dark-coloured, belly hard and tumid, and fre- 
 quently he complained of griping pains about 
 the umbilicus. 
 
 Emetics were had recourse to without effect, 
 but as the symptoms of worms were unequi- 
 vocal, he was put on a course of strong anthel- 
 mintics, and vermes of the lumbrici kind were 
 passed in abundance. The general health 
 shortly after this improved daily, and what 
 proves that the hearing was affected sympathe- 
 tically, was the restoration of this sense on the 
 other complaints being got rid of. 
 
 No topical means were applied in these cases, 
 but the ci^re was wholly effected by having de- 
 tected and remedied the remote, yet indubi- 
 table source of the deafness. 
 
126 
 
 CASE XXI. 
 
 Susan Vaughan was admitted a patient of 
 the Royal Dispensary on the 6th of September. 
 She complained of a violent pain in her left ear, 
 which annoyed her exceedingly : the meatus 
 auditorius appeared considerably enlarged. By 
 continuing the use of a stimulating liniment by 
 means of a bougie, she was surprised one morn- 
 ing to find a worm, nearly two inches long, 
 come from her ear ; and by continuing the use 
 of the application, in the course of a week a 
 second was ejected, leaving a discharge, which 
 yielded in a little time to an astringent injec- 
 tion. Her hearing is now perfectly recovered. 
 
 CASE XXII. 
 
 Robert Cartwright had been deaf nine 
 years when admitted a patient at the Royal 
 Dispensary : his deafness at the same time was 
 
127 
 
 attended with a pnriform discharge from the 
 tympanum. By adopting the plan already re- 
 commended, he is now quite well. 
 
 CASE XXIII. 
 
 Mr. Y. applied to me with a most obstinate 
 case of nervous deafness, as he expressed him- 
 self, for which he had tried a variety of means 
 to obtain relief ; and being a medical man he 
 had consulted most of his acquaintance. As I 
 considered it a good case for the new mode of 
 practice I mentioned in a former part of this 
 work, I began by excluding the external air 
 from the meatus, which was continued for some 
 days ; at the expiration of a month he lost the 
 violent noise in his head, which had so much 
 distressed him, and in a fortnight after this 
 by continuing the plan his hearing returned. 
 
 x 
 
128 
 
 The number of cases of incipient nervous 
 deafness, which I have successfully treated, 
 only convinces me, that if early attended to, 
 they are more easy of cure than is generally 
 imagined. 
 
 CASE XXIV. 
 
 Mr. Y., a young man twenty-seven years oi 
 age, applied to me with an obstruction of the 
 Eustachian tube, which, from what he informed 
 me, I was induced to think proceeded from a 
 syphilitic cause. After using a stimulating 
 gargle for some time without effect, l was in- 
 duced to perform the operation of puncturing 
 the tympanum, which succeeded instantly in 
 restoring his hearing ; but 1 had some difficulty 
 in preventing the aperture from again uniting. 
 The edges of the wound became fistulous, and 
 in a few weeks the membrane recovered its 
 usual tension ; and his hearing is now restored. 
 
129 
 
 It may be proper to remark here, that in slight 
 cases of obstruction of the Eustachian tube, I 
 have found a slight stimulating gargle of the 
 greatest service, and in my opinion it deserves a 
 trial in cases that are supposed to proceed from 
 this cause ; as the remedy is simple, its appli- 
 cation cannot be attended with any unpleasant 
 effect. It may, indeed, make the throat a little 
 sore ; but that soon goes off. 
 
 An obstruction may proceed from various 
 causes, as I mentioned in a former part of the 
 Work; but the most frequent cause is a cold, 
 when the orifice of the tube becomes swollen : 
 in that case a gargle is of great service. 
 
 CASE XXV. 
 
 Mr. W. came to me with an unusual sensa- 
 tion of both ears, which he had laboured under 
 
 for some years. On inspection, I perceived 
 
 x 2 
 
130 
 
 there was a quantity of cerumen in a very hard 
 state, collected at the bottom of the meatus. 
 By continuing to syringe the ears, the whole 
 was removed. On the first application of the 
 syringe, which brought away a considerable 
 quantity, he was able to hear the church clock 
 strike, which he had not done for several years 
 before. What makes this case rather singular, 
 is, that this gentleman conceived he laboured 
 under a violent nervous affection, and came to 
 me for the purpose of obtaining a trumpet ; 
 which not answering his expectations, I pre- 
 vailed on him to let me examine the state of 
 his ears. I need not mention that he was much 
 pleased at being relieved by such simple means. 
 
 Many other cases of a similar nature have 
 come under my observation ; all which point 
 out the necessity of minute examination, in 
 order to ascertain the cause of the defect, before 
 offering any decided opinion. 
 
231 
 
 la the dissection of the ears of those who 
 have been deaf for many years, whatever other 
 derangement of structure may exist, there is 
 always a quantity of inspissated wax in the 
 passage, in a very hard state, as formerly men- 
 tioned ; which shews, that a morbid condition 
 of the organ necessarily affects the secretion of 
 this part, and that the secretion itself accumu- 
 lated in this way may act as an additional 
 mechanical cause in increasing the obstruction 
 of hearing. 
 
 CASE XXVI. 
 
 Thomas Hamilton, a boy seven years of age, 
 was brought by his mother to the Royal Dis- 
 pensary. She informed me he had been both 
 deaf and dumb from his birth. Although I did 
 not give her any considerable hopes of cure, I 
 was desirous of attempting relief. I accordingly 
 employed the same mode of treatment as I have 
 recommended in cases of nervous deafness ; 
 
132 
 
 having, however, previously ordered the ears to 
 be well syringed. He was admitted on the 
 22d of April, 1817 ; and since that time his 
 hearing has been regularly improving, and he 
 has also acquired the faculty of speech. 
 
 CASE XXVII. 
 
 Miss B., aged fifteen years, had been from her 
 birth deaf and dumb, and when she was first 
 brought to my house, she could neither hear 
 nor articulate a word. Being the daughter of 
 wealthy parents her education had been well 
 attended to, for she could write remarkably 
 well, and play on the piano forte. This case I 
 treated in a similar manner to the preceding 
 ones : with the assistance of excluding the ex- 
 ternal air from the meatus, at the same time 
 exciting a slight degree of inflammation at the 
 bottom of it, my success was here equal, for the 
 young lady can now hear and speak. 
 
133 
 
 CASE XXVIII. 
 
 Charles Vernon, aged twenty-eight years, 
 was admitted a patient at the Royal Dispensary 
 on the 24th of April, at the recommendation 
 of a Royal Physician. On enquiry, I found 
 he was deaf and dumb, and that he had been 
 four years in the Deaf and Dumb Asylum in 
 the Kent-road. As I was desirous of attempt- 
 ing relief, I employed the same means as in the 
 preceding case, and not without considerable 
 effect ; for in the course of a short time he was 
 able to hear sounds distinctly. I regret that 1 
 had not an opportunity of following up the 
 plan I had laid down, and which was pursued 
 with so much apparent advantage, as he went to 
 Scotland to superintend his brother’s business, 
 he being an excellent mechanic, content with, 
 and grateful for, the benefit he had already 
 received. 
 
134 
 
 CASE XXIX. 
 
 Miss W., a very interesting young lady, was 
 brought to me by her mother, who informed me 
 that she had been deaf and dumb from birth. 
 By adopting local remedies and constitutional 
 treatment, I have the satisfaction to find that 
 she hears sounds, such as a clock strike, a dog 
 bark, &c. which she did not do before ; and 
 by steadily following the plan of cure which I 
 prescribed, her medical attendant and I concur 
 in the well founded expectation that she will 
 shortly obtain her perfect hearing. 
 
 Several cases have occurred to me in my 
 practice, where children have been very back- 
 ward in acquiring their speech, which I had 
 every reason to suppose proceeded from deaf- 
 ness ; for having had the ears syringed, and 
 employing the means already detailed, a visible 
 alteration soon took place, and they began to 
 
335 
 
 learn to talk very fast. In the same manner I 
 am inclined to think that if every child who is 
 supposed to be born deaf and dumb, were to 
 have the ears 'properly examined and syringed, 
 it would be frequently attended with very good 
 effect, and these imperfections in many cases 
 removed. 
 
 I have no doubt that frequently in childhood, 
 for w ant of something being done by way of 
 relief, the deafness becomes confirmed, and 
 dumbness follows. The plan I have proposed 
 in such cases is simple, and is not attended 
 with any danger: I therefore hope it will be 
 followed by all who have deaf children. 
 
 I shall not tire the reader with a recital of 
 any more cases : the few 1 have inserted will be 
 sufficient to show, that diseases of the ear, like 
 diseases of other parts of the body, are often 
 curable, and that, in a great number of cases, 
 the hearing is only impaired, not lost ; hence 
 
1.36 
 
 the necessity of attending to them. Although, 
 it must be confessed, many are involved in great 
 obscurity, yet that number is small, when com- 
 pared with those in which, with attention, the 
 cause of disease may be discovered, and a cure 
 effected. 
 
 FINIS. 
 
 Andersen id Co. Printers, 4, Broadway, Blackfriars. 
 
ERRATA. 
 
 Page 53, line 16, for ceruix read cervix. 
 56, — 14, for solven read solvent. 
 74, — 4, for training read tracing. 
 

 
 
eije ifcogal ©tgpen3ati> 
 
 FOR DISEASES OF THE EAR, 
 
 For the Relief of the Poor, 
 
 CARLISLE STREET, SOHO SQUARE. 
 
 ~^€g>0=~ 
 
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 AND HIS ROYAL HIGHNESS THE DUKE OF CUMBERLAND. 
 
 THE MOST NOBLE MARQUESS CAMDEN, K.G. 
 
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 The Duke of Norfolk, 
 
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 The Marquess of Hertford, 
 The Marquess of Anglesey, 
 The Earl of Egremont, 
 
 The Earl of Ashburnham, 
 The Earl Fitzwilliam, 
 
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 Viscount Dudley and Ward, ‘ Henry Cline, Fsq. F.R.S. 
 
 Consulting Physician — John Sims, M.D. F.R.S. 
 Surgeon — J. H. Curtis, Esq. | Treasurer — W. Cobbe, Esq. 
 Secretary — Mr. G. Whiting. [ Collector — Mr. Pearce. 
 
 The Diseases of the Ear affect every rank of society; 
 and to the lower classes, engaged in a variety of domestic 
 occupations, Deafness is a most serious misfortune, as it 
 
either causes them to be dismissed from their situations as 
 servants, or, if they are retained, it is attended with much 
 inconvenience to their employers. 
 
 It is to obviate these evils, so distressing to the lower 
 orders, that the present Institution is established, in which 
 every surgical aid is given that the nature of the subject 
 admits ; and if the inconvenience cannot altogether be re- 
 medied, the patient is supplied, free of expense, with such 
 artificial means as have been found by experience useful in 
 such imperfections of the organ. 
 
 Every Subscriber of One Guinea per Annum is enti- 
 tled to one Patient always on the Books; Two Guineas 
 entitles two Patients, and so in proportion ; Ten Guineas 
 constitutes a Life Governor. 
 
 Subscriptions are received at the Banking Houses of Sir 
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 upwards of 1,000 Patients had been received, the greater 
 number of whom, to the satisfaction of the Governors, had 
 been cured or relieved, and thereby rendered capable of 
 following their various employments, to which before they 
 were incompetent. 
 
THE PLAN OF LECTURES 
 
 ON THE 
 
 anatomy, ^fjyiStology, ana Radiology 
 
 OF 
 
 THE EAR, 
 
 BY JOHN HARRISON CURTIS, Esa. 
 
 Aurist to His Royal Highness the Prince Regent, His Royal Highness the 
 Duke of Kent, and to their Royal Highnesses the Duke and Duchess of 
 Gloucester; Surgeon to the Royal Dispensary for the Diseases of the 
 Ear, Fellow of the Medical Society of London, &c. &c. 
 
 To commence on Friday , ls£ October , 1819. 
 At Seven o’Clock in the Evening, 
 
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 CARLISLE STREET, SOHO. 
 
 ARRANGEMENT OF THE COURSE. 
 
 In the Introductory Part will be considered, the Impor- 
 tance of the the Sense of Hearing- as the medium of social 
 intercourse; the various degrees of this Sense in the 
 several tribes of Animals; with the different construction 
 of the organ for that purpose. 
 
 The Anatomy of the Human Ear will be described, as 
 divided into external, intermediate, and internal parts ; and 
 the description will be illustrated by anatomical preparations. 
 
 The Physiology, or Uses of the different parts of the Ear, 
 will be next examined. 
 
 On finishing the Structure and Uses of the Ear, the 
 various Diseases occasioning Deafness will then be consi- 
 dered, treating them in the same order in which the Struc- 
 ture has been described. 
 
This order will comprehend, first, the Affections of the 
 external Ear, or Meatus Auditorius ; secondly, those of 
 the Tympanum, viz. its puriform discharge, and the Ob- 
 struction of the Eustachian Tube, with the operation ; 
 thirdly, the Diseases of the Labyrinth, whether constitu- 
 tional, as nervous, scrofulous, syphilitic, &c. ; or local, as 
 Paralysis of the Auditory Nerve, defective Organization, &c. 
 
 The Subject will conclude with general Remarks, appli- 
 caple to this class of Diseases ; and on the little progress 
 formerly made to improve the knowledge of them. 
 
 A Clinical Lecture will be given during each Course 
 on the most important Cases that occur at the Royal Dis- 
 pensary. 
 
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