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Dr. Albert H. Buck* says: "I have repeatedly been called to see children who have been suffering from pain in the ear several days, and in whom the inflammation of the middle ear and adjacent parts had already assumed serious proportions; and yet the thought of sending for a physician had apparently not entered the minds of the parents until after the inflammation had approached very near to the limit beyond which surgical interference is not competent to control the disease. I have often, in these cases, asked the parents the question: 'Why have you waited for so long a time before sending for a physician?' The majority have replied: 'We thought it was simply an earache, and that it would pass off of itself?' Others have said that in the previous earaches of their children, the physician who had been called simply prescribed the application of a hot poultice, or the instillation of warm sweet oil to which a few drops of laudanum were to be added; and that they naturally drew the inference that nothing further could be done in such cases." It would seem natural for this celebrated instructor in Otology to follow up this statement, as he has, with the remark, that, "in every case of earache, which does not yield readily to local applications of heat, a physician should be sent for in order that the underlying pathological condition may be ascertained and the proper remedy applied." "Unfortunately for the public," he further remarks, "very few physicians in the country districts," and comparatively but very few in the town and city districts, should have been added, "are provided with the proper instruments, or possess sufficient technical knowledge, for the satisfactory accomplishment of this object."
When one looks at the practice of medicine alone, he is not at all surprised to find constant improvements being made in the treatment of disease; also in Materia Medica, where new, direct and pleasanter remedies are constantly being discovered, and their usefulness developed. So also in Surgery, wherein new and better styles of operation are invented, and various modifications in regard to instruments, manipulations and mechanical contrivances. But, when we come to
*See Diagnosis and Treatment of Ear-Diseases, p. 156, 1880.
otology, many are so prone to regard that as the field of the specialist that they think it either beyond their ken, or that no further improvement can come within its jurisdiction; and hence after treating, it may be their first case of earache, successfully, they rarely if ever read up on that branch of medicine during the rest of their natural lives. This should not be the case, especially with the live, wide-awake Eclectic physician. Otology presents a wide and interesting field for continuous and unremitting study. Not that I consider the Eclectic, behind other schools in the profession in this direction, but to prove that otology does not receive its appropriate attention, I might mention the fact that, according to the published transactions of this society, it has generally received the go-by, and is very seldom reported upon.
In conclusion, the great importance of a thorough knowledge of this somewhat intricate subject to every medical man is so obvious as to require no excuse for the time I have devoted to it. The rehearsal of acknowledged facts sufficiently recalls to the mind the pathological importance of the Eustachian tube and naso-pharynx, to cause these structures to be considered, for other than anatomical reasons, a part of the ear. May we not conclude, that for therapeutical purposes, also, they are the most important part of the ear? Hardly a case of what would seem, at first sight, to be a simple catarrh of the naso-pharynx, can pass through our hands, but that if we watch carefully, and keep our etiological and pathological eyes open we may ascertain some new fact, which in the future might make us more welcome to our patients and useful in our calling.
PERFORATION OF THE MEMBRANA TYMPANI
By S. W. INGRAHAM, M. D., Chicago, Ill.
The tympanum is an irregular cavity in the petrous portion of the temporal bone. It is separated from the meatus on the outside by the membrana tympani; and connecting posteriorly with the mastoid cells, on its anterior face with the pharynx
and Eustachian tube, and internally with the labyrinth by the fenestra ovalis and fenestra rotunda. The membrana tympani or ear-drum membrane, therefore, bounds the tympanum. It is concave on the outside in the direction of the meatus, and convex interiorly.
The Eustachian tube extends from the pharynx to the anterior circle of the tympanum. It is partly fibro-cartilaginous and partly osseous; it is wider at its pharyngeal extremity, and becomes narrower as it approaches the tympanic cavity.
The perforation of the membrana tympani is doubtless occasioned in the great majority of instances by otitis. Nevertheless, it may be from other well-known causes; as from syphilis, scrofula, or direct injury through the meatus, puncturing and rendering it liable to inflammation and suppuration.
In cases of perforated membrane, the patient complains of a whistling or singing sound in the ear; and some will describe this sound as resembling that of the rush of wind or When the perforation is complete, the uneasiness and itching sensation often so well marked in otorrhoea, passes away. There will be a confusion of sounds; the voice will be altered in accent and upon a lower key; the throat will usually be inflamed; and the system as a whole will be in a wretched condition. There will be a purulent or muco-purulent fluid, oftentimes very offensive in small, discharged from the meatus; and also a disagreeable taste in the mouth.
It is necessary to ascertain the habits and general health of the patient, as well as the condition of the ear. We should direct the use of a plain, easily-digested diet, careful observance of the laws of hygiene, and require sleeping in a dry, airy, sunshiny apartment.
In case of syphilitic lesion, a preparation should be administered, consisting of Iris versicolor, compound syrup of sarsaparilla and potassium iodide. This should be followed up for weeks, and even months in obstinate cases.
If the patient is scrofulous, the syrup of Ferrum iodide, quinia and cod-liver oil will be beneficial.
If the Eustachian tube is closed so that a free current of air cannot be passed through it from the lungs to the membrana tympani, as well as through the nose, we should have recourse to the Eustachian catheter. By opening the tube and keeping it open the sense of hearing will be greatly improved. During the past five years I have had but little use for the eartrumpet and I am of the opinion that it has outlasted its day of usefulness, and that recourse will in the future be had to the means of relief through the judicious use of dilators or cathThe Eustachian tube is of wonderful importance to an injured membrana tympani, by acting the part of conductor of sound with room for complete resonance to occur. It thereby assists the injured member in the act of audition.
In conclusion I will remark that I know of no method that will accomplish so much good in cases of large perforation of the membrana tympani as the one referred to; but it may become necessary—or even be necessary to use anodyne and astringent injections. There is nothing better for this purpose than the deodorised tincture of opium and solution of the nitrate of silver. If the inflammation has passed off without leaving the mucuous membrane in a hypertrophied state this will prove to be what is wanted; no matter how much of a hole or cavity there is in the membrana tympani.
By GEORG E. POTTER, M. D., Johnstown, Penn.
The ear is that organ situated on and in the temporal bones on each side of the head. It consists of three anatomical divisions, viz the external, or auricle, including the meatus auditorius externus. The middle, or tympanum, is an irregular bony cavity occupying the outer part of the petrous portion of the temporal bone. It is bounded externally by the membrana tympani, ane internally by a thin plate of bone, which
is perforated by two foramina, the fenestra ovalis and rotunda. It contains a number of smaller foramina (which communicate with other parts), air, and the osseous chain, which is composed of the malleus, incus and stapes. The internal, or labyrinth, is divided into a half-dozen or more parts, but it is not deemed necessary to mention them in this connection. What has been said of the structure of the ear will suffice for our present purpose.
The ear, from its delicate construction and relation to the mucous membrane, lining the posterior nares, is liable to various functional and organic diseases. Acute and chronic inflammation are the most common ailments affecting this organ.
The various causes that produce imflammatory conditions in other parts of the body have the same effect upon the membranes lining the cavities of the ear, viz.; cold, injuries, foreign bodies introduced into the cavities, and sequels of the exanthematous diseases.
The busy practitioner during his daily labors will meet with quite a number of patients, especially children, who have a discharge of nastiness from one or both ears, and upon inquiry we find it almost invariably to be the result of an attack of scarlatina, measles, or some of the eruptive diseases.
The object of presenting this short essay is to report a fewcases of otorrhoea, and the treatment pursued. My first was. that of a lady aged twenty-three, who for several years suffered from partial deafness of the ear. During the early part. of December last she contracted a severe cold which settled in the right ear, causing great pain and suffering. Poultices. and fomentations had been used to very little advantage. About the middle of the same month she applied to me for treatment. I found the ear swollen and painful, and by drawing the auricle upward and backward, a polypus presented. itself, filling up the entire meatus. This was very tender to the touch and of a grayish color. Upon a closer examination, be means of a probe, I found the polypus to be about one-half of an inch long, and attached to the posterior superior lateral surface of the meatus, near the membrana tympani. There