are directed upwards, it may be introduced with great ease. It is right to bear in mind also, that the membrana tympani is not placed horizontally at the bottom of the meatus; but that it takes an oblique direction; so much so, that it forms a very acute angle at the lower, and an equally obtuse angle at the upper side of the boney external meatus; to which it is at first nearly parallel. If, therefore, the instrument be curved, so as to correspond to the obliquity of the passage, with its convexity upward, while the concavity is applied to the convexity of the lower side of the meatus, the cutting angle will not only enter the lowest part of the membrane, but it will also wound the bottom of the cavitas tympani. In this position indeed the opening of the tympanum will be quite uncertain, for the instrument may enter at the acute angle formed by the union of the membrana tympani with the lower side of the meatus

externus.

A short time since I had a case of deafness, resulting from an attack of scarlet fever in 1802, which had been attended with violent inflammation of the tonsils and adjacent parts. The patient could not hear unless she was spoken to in a loud tone of voice. As the constitution was perfectly good, I im mediately punctured the membrana tympani. I was instantly apprized of success, by the patient declaring with a strong emotion of joy, that she could "hear the clock tick;" that her "ears cracked;" afterwards, succeeded a confused noise, and sounds were distinguished that she had not heard since the scarlet fever. Her hearing soon became exceedingly painful. In a short time, by putting a small piece of wool into each meatus, the sensibility of the organ diminished, and it adapted itself to the new impressions of sound; and the patient finally declared, "I can hear almost as well as I could at fifteen." The same success attended a similar operation, where one of the Eustachian tubes was obstructed.

Another young lady had laboured under a defect of hearing for five years. It had declined gradually till she was incapable of hearing a conversation in any tone of voice. There was a defective secretion of cerumen. From examination of the state of the Eustachian tubes, I found. that by closing the mouth and nose, and then attempting to expire, she could not VOL. VIII. No. 30.

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distinguish the least noise in the ears; consequently I concluded, that they were obstructed; although, from the gradual approach of the deafness, without any previous affection of the fauces, I had some doubts. But as no harm could arise, I punctured the membrana tympani; and I regret to add, that the operation did not succeed, This failure induced me more accurately to examine the state of the Eustachian tubes; and on the patient clearly understanding, which she did not before, what I meant by a sensation of swelling in the ears when forcibly expiring, she was sensible upon further trial, of such an effect. This, therefore, proved a case in which the operation could not be expected to succeed, because the air within the cavitas tympani was free. This patient had decidedly a scrofulous habit. I immediately adopted a suitable mode of treatment, from which she derived considerable advantage. She took a calomel pill and saline purgative every seventh day; and in the interval, mineral tonics. I ordered the ears to be fumigated three times a day, with strong camphorated spirit*; and stimulated night and morning by a liniment composed of ceratum resinæ, oleum olivæ, and a small portion of tinctura lytta, and spiritus ammoniæ compositus applied with a camel's hair pencil. By these means I hoped to restore the secretion of wax. In this regimen she persevered as long as I thought requisite; and she now enjoys conversation in the society of her friends. By occasionally varying the internal and external remedies, she is still sensible of improvement.

There are numerous cases on record which directly prove, that the membrana tympani is not essentially necessary to the faculty of distinguishing sound; therefore we may conclude, that it can be punctured without detriment. Mr. Astley Cooper has noticed an instance, in which the membrana tympani of one ear was totally destroyed by disease, and that of

*This was proposed to me by my ingenious friend Mr Edward Turner Bennett, who also suggested Mudge's inhaler as a fit apparatus to be used in this case. I procured one, and set it upon an iron stand four inches high; then filling it half full of hot water, I added two tea spoonfuls of strong camphorated spirit, and placed a spirit-lamp underneath. The vapour rose through the flexible tube, the extremity of which was then applied to the external meatus.

the other nearly so; the deafness appeared inconsiderable; and the hearing in the ear, in which no trace of the membrane could be found, was distinct. In similar cases, the ear is sometimes acutely sensible of musical tones, and accurately judges of time. Some persons are capable of driving smoke from the mouth through the meatus externus*; and in them there is great accuracy of hearing. In this instance, the opening in the membrana tympani must be formed artificially, and most likely by the efforts of the individual; as the most exact researches, I believe, have discovered no such communication existing in the natural structure of the parts. But a natural foramen is particularly described by Professor Rivinus, of Leipzic, whose name it long bore. This foramen, however, is not admitted by modern anatomists to exist. I have repeatedly found this opening in cats and some other animals; but I never could trace the smallest appearance of it in man.

If we enquire into the use of the ossicula in the cavitas tympani, they also are by no means necessary for distinguishing sound; since, in cases where there has been inflammation and suppuration of the cavity destroying the membrana tympani, so that the bones have escaped, the sense of hearing has still remained. But in these cases, the membrana fenestræ ovalis must remain entire, otherwise the aqueous contents of the labyrinth would escape; whereby all power of hearing is completely destroyed. If, when the parts external to the labyrinth are lost, sounds can be distinguished, it follows that the ossicula have no share is transmitting the sonorous vibrations, the contrary of which has been generally believed, and that the air in the cavitas tympani gives the impulse of sound to the fluid of the labyrinth. Otherwise how is it that an obstruction of the Eustachian canals diminishes, in so great a degree, the faculty of the organ? The air thus confined cannot prevent sound passing through the medium of bone. The ossicula themselves, therefore, are to be considered as secondary agents, designed to enable the impulse of sound, thus transmitted, to act with more

This phenomenon, I am informed, is very general among the North American Indians.

correctness and accuracy on the membranes to which they are connected. The membrana tympani, being furnished with a contractile and relaxing power, its use is, I think, analogous with the iris, to the sight, by regulating the intensity of the violent impulses of sound, and increasing the power of the weak. When our attention is directed to a low tone, the membrane is rendered tense; but the opposite state takes place when loud tones are transmitted to the organ. Considering, therefore, the use of the parts severally, which are external to the labyrinth, and the degree of deafness from the want of each separately or conjointly, it will be found, that where the Eustachian tubes are obstructed, the power of hearing will be more diminished than where a part of the membrana tympani is destroyed. And sometimes it will be equal, if not greater, than that which is occasioned by the loss of the whole membrane and ossicula. In every case of this kind, therefore, it will be advise able to open the tympanum, which may be done in the manner I have directed.

Hence it appears, that provided the rays of sound are conveyed to the membrana fenestræ ovalis, the functions of the organ will be performed with sufficient accuracy, and that this membrane is one of the most essential to hearing; that the functions of the ossicula and membrana tympani are merely accessary, and are principally employed in regulating the transmission of sonorous rays to the necessary parts of the organ, and in protecting those which are more delicate.

New method of extracting the Stone from the Bladder, without the formidable operation of cutting. In a Letter from DR. CALVIN CONANT, to the Honourable SAMUEL L. MITCHILL, dated August 14, 1817.

of

[From the New-York Medical Repository, for November, 1817.]
HONOURED SIR,

A few months ago I was called to visit a boy of fifteen years age, who had long been troubled with frequent suppressions

New method of extracting the Stone from the Bladder. 181

of urine, in consequence of a loose stone, which occasionally fell into, or upon the sphincter of the bladder.

I frequently introduced a small silver catheter, and removed the stone from over the sphincter; and in this way daily evacuated his water, administering soda and other medicines generally used in such cases, without any apparent success. Worn out with daily toil, I at length resolved, if possible, to extract the stone.

For this purpose I furnished myself with a very fine silver wire, about twenty inches long; made elastic, by being frequently drawn through a wire-plate, without being annealed.

I then drilled two holes through the fore end of the catheter, upon the convex part, about one-eight of an inch asunder, through which I passed the two ends of the wire, bringing them through from the anterior to the posterior part of the catheter.

I soon found, by shoving the wire forward, that a handsome loop was formed, and that by pulling the two ends back the loop would be brought in so close a contact with the end of the catheter as to be no material hindrance to its introduction into the urethra.

Thus prepared, I visited the boy, and determined to extract the stone, provided I could enloop it, and should find it so small as not to endanger a laceration of the urethra in its extraction; to determine which, I had graduated the ends of my wire into spaces of a quarter of an inch each.

Having introduced the catheter, felt out and enlooped the stone, which was done with little difficulty, I examined my scale and found one inch and a quarter of the wire was taken up in surrounding it; I changed its situation and enlooped it anew a number of times, until I found I had enclosed it in such a manner as to occupy the greatest length of loop, which at this time was one inch and seven-eighths. By this I knew I should be able to bring the stone and wire into the urethra, which would not expose it to so great a laceration.

Having drawn my ends of the wire very tight to keep the stone firmly enclosed in the loop, I proceeded, with gentle