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WORKS BY W. R. WILDE.

NARRATIVE

OF

A VOYAGE TO MADEIRA, TENERIFFE, AND ALONG THE SHORES OF THE MEDITERRANEAN;

! INCLUDIXO A VISIT TO

ALGIERS, EGYPT, PALESTINE, TY&B, KH0DB3, TEUCESSUS, CYPRUS, AND GREECE :

With Observations on the present State and Prospects of Egypt and Palestine, and on tha Climate^ Natural History, and Antiquities of

the Coontries visited.

Second Edition, enlarged, with Maps and other Illustrations. 8vo.

AUSTRIA : ITS LITERARY, SCIENTIFIC, AND MEDICAL

INSTITUTIONS ;

With Notes on the State of Science, and a Guide to the Hospitals and Sanitory

Establishments of Vienna. Crown 8vo.

THE CLOSING YEARS OF DEAN SWIFT'S LIFE :

With Bemarks on Stella, and on lome of his Writings hitherto unnoticed.

Second Edition, enlarged, with Portrait of Stella, and other

Illustrations. 8vo.

THE BOTNE AND THE BLACKWATER:

lllustrattb ^iBioruallg nxib iropogrupljunlln.

Second Edition, enlarged, with a Map, an Itinerary, Plan of the Battle of the Boync, and Eighty-four Illustrations engraved on Woud. Cruwn 8vo.

IRISH POPULAR SUPERSTITIONS.

Crown 8vo.

OBSERVATIONS

Ul'OX

THE EPIDEMIC OPHTHALMIA

Which has provailed in the Irish Workhouses.

8vo.

In the rrets.

THE CONGENITAL MALFORMATIONS AND DISEASES OF

THE ORGANSQE^GHT.

PRACTICAL OBSERVATIONS

OM

AURAL SURGERY

AND

THE NATTJBE AND TBEATMENT

OF

DISEASES OF THE EAR,

WITH ILLUSTRATIONS.

BY

WILLIAM R. WILDE,

wwLLcm or the botal ooujeob op bdroiohs nr ibkulMDi sdbobom to n. mark'm ophthalmic hohpitali

BOMOBAKT MBfMB OP Tin BOTAL MBDIOAL SOCnriT OP BrOCKHOLIf ,

KtV» BTC.

LONDON: JOHN CHURCHILL, PRINCE'S-STREET, SOHO.

DUBMN : FANNIN & CO. EDINBURGH : MACLACHLAN & CO.

MDCCCLIII.

/<^^.. a.. ///.

ouBLor:

BT M. H. OIUo

TO HIS EXCELLENCV

EDWARD GRANVILLE, EARL OF ST. GERMANS,

LORD LIEUTENANT GENERAL AND GENERAL GOVEBNOE OF IRELAND.

ETC..

THIS WORK 18,

BY HIS EXCELLENCY'S PERMISSION,

AS A &LA.RK OF RESPECT FOR HIS PUBLIC CHARACTER, AND OF PERSONAL GRATITUDE^

BY

THE AUTHOR.

PREFACE.

In the Introductory Chapter I have entered so fully into the circumstances attending the publication of this work, that but few prefatory observations are necessary. I have laboured, and I trust not in vain, to expose error and establish truth ; to lay down just principles for an accurate diagnosis of Diseases of the Ear ; to rescue their treatment from empiricism, and found it upon the well- established laws of modem pathology, practical surgery, and reasonable therapeutics. In dealing with my sub- ject it was necessary to review the practice and opinions of others : yet, though on certain points a conscientious difference from other writers has been expressed, I have not failed to award merit where merit was due.

My friend and former pupil, Dr. Addinell Hewson, of Philadelphia, has consented to edit the American edition of this book, now in course of publication by Messrs. Blanchard and Lea ; and my friend Dr. von Haselberg, of Stralsund, has kindly undertaken the translation of it into German.

Dublin, 21, Westland-row, June 12, 1853.

CONTENTS.

CHAPTER L

PAOB. iKTRODUCnON AND BiBUOORAPHT, 1

CHAPTER II. MicAifs OF DiAONoeis, 5t

CHAPTER III. Statistics and Nosology of Ear Disbases, 97

CHAPTER IV.

DiSKASES OF THE AURICLR, BIaSTOID ReOION, AND EXTERNAL BfBATUS, ... 160

CHAPTER V. Diseases of the Membrana Ttmpani, 210

CHAPTER VI. Diseases of the Middle Ear and Eustaobian Tube, 811

CHAPTER VII. Diseases op the Internal Ear, 871

CHAPTER VIIL Otorrrcea, 894

APPENDIX.

DSAF-DtTMBNESS, , 486

IiTDSZ, 497

A TREATISE

OK

DISEASES OF THE EAR.

CHAPTER I.

IHTBODDCTIOB AHS BIBUOaBAFHT.

Iotn>di>ctoi7ltaiiaTkionAaral3argciy. Former idwim of ii!UgiMiiU,«ndgai««l know- ledge of the subject. Early History of tbe Art— Writings of the Andents tna

Hippocralea to Gslen.— Discoveries of the AnUomisU of thB aiteenth (Hitiiiy.— Irish 'TrusUtloDS.—HercarisUs.^InstnicliailDrUieDofuidEhimb Hearnios. JatiO' ductioD ortheSpe<:nliuiib7Fsbridas._BoDet snd Da Verney Kennedy.— Eusta- diim CUfaeteriBD by Gnyot English AoiiOs : Clelud sod W«lhuj.— la^Aerin.—

DfgTSTen. VsIssIts sod Cassebohm. Sims snd the London Hedkal Sode^

Gnbun snd Elliott. Quacks and Quackerf. Perfoiation of Histoid Process^

Oieselden. Porfontioa of tbe Membrana Tj-mpani liy Sir A. Cooper Saunde™. Outii and his (bOowera ; Stephensan, WilUams, Wright, Webster, Hc?'""!^. *^ Gaidoer— BachansD, Esrk, Tod, Swan and Canrell The French School ; Laennec, Itsrd, and Deleau.— Ths Germaii School: Eruner, SchmaU, Lincke, snd Prsnk The Hodem BngUsh Scbool: Toynbee, Pitcher, Whaiton Jone^ Williams, Teanley, Harvey, Dnlton, and Waketey. Tamboll and Ms Boviewen.— Beqdsite* fin an Anrsl SorgeoD, and what Aural Sarger; can etftct.

XN the following Treatise I purpose writing, for the information -*~ of practitioners and studenta in medicine, the history, symp- toms, causes, mode of treatment, and results of the moat frequent and remarkable diseasesof the Ear. With rospeot to my competency to this task, I have but to remark, that I have had very ample op- portanities for studying these diseases during the last tea yean in an extenmve practice, and in the management of a large public institution in Dublin, for a long time the only one of the kind open to the student where clinical and practical instruction in Aural Surgery ma delivered in Great Britua.

2 INTRODUCTOfiT REMARKS.

This work is the result of the experience thus acquired. De- tached portions of it, clinical lectures, and cases observed at St. Mark's Hospital, have already appeared in the periodicals of this country, and some of these essays have been translated and pub- lished separately on the Continent. All these, together with much additional information gleaned since their publication, are em- bodied in this book, which does not profess to be a complete sys- tem of Aural Surgery, giving a full description of all the diseases of the Ear which have been recorded by authors ; but is intended to supply the reader with a practical treatise on the most frequent and urgent affections of the organ of hearing, and those that I my- self am best acquainted with. It may, therefore, be regarded some- what in the light of a monograph, a form of publication peculiar to this School, and one generally containing more useful and prac- tical information than either a large systematic work or a manual.

In studying the diseases of the Ear, my object has been to take as a basis the principles of pathology : and to reduce their treatment, local as well as general, to the recognised rules of mo- dem therapeutics and scientific surgery ; but, above all, I have laboured to divest this branch of medicine of that shroud of quackery, medical as well as popular, with which, until lately, it has been encompassed.

Country friends often ask me, " Have you found out any new cure for deafness T I do not profess to invent or introduce new remedies. I try to make the well-established rules of practice in the treatment of other organs applicable to the management of aural diseases. Like most students, I was taught during my ap- prenticeship theoretically to believe, and practically to observe, that we *' knew nothing about the diseases of the organs of hear- ing." This was the dictum honestly expressed by the " heads of the Profession," men from whom the public were willing to re- ceive a fearless, candid opinion, either immediately on being con- sulted, or after a few trials of the "ordinary means;" to wit, syringing with hot water and soap, either Castile, soft, yellow, or old brown Windsor, in the hope that the deafness or the noise in the ears might arise from a collection of hardened wax ; then setting the digestive organs to rights by purgation, and a '< course

FORMER MEANS OF DIAGNOSIS AND TREATMENT. 3

of bitters," lest the affection might be " owing to the stomach." The human stomach has much to answer for in deranging the system generally, no doubt; but the mischief of which it is daily accused, as every one extensively engaged in practice is well aware, is beyond belief. There is scarcely a disease which we treat, no matter how local, upon which, if we question the patient as to its duration, that he will not say, " Oh I it is, indeed, of pretty long standing, but I was waiting to have my stomach put to rights, as I am told I am very bilious." Next in order, blistering behind the ears is tried, in order to draw away some peccant humour that had, perhaps^ accumulated round the deli- cate organ of hearing. These and such like methods failing to give relief, stimulants, often of a very acrid nature, are poured into the external auditory passages, either to restore the secretion, un- der the impression that what is a mere attending symptom is the disease, or to excite or rouse the dormant nervous power; and hot tinctures, turpentine, creasote, and pungent essential oils are iCpplied to the external surface of the tympanal membrane with- out mercy. Some practitioners resort to more palliative means, recommending some warm almond oil to be dropped into the ear at bedtime, or eau de Cologne to be rubbed upon the side of the cheek adjoining the auricle, at the same time advising a lit- tle black wool to be retained in the meatus, in order to preserve the organ from cold. To give, however, fair play to the latter remedy, it should be prescribed in full, and according to the old popular superstition, but one which is still extensively re- sorted to, the wool should be procured from the left fore-foot of a six years' old black ram ! Some advise a slice of fat bacon to be inserted into the meatus every second night; and glycerine is now the fashionable remedy. All these means having failed to give relief, the patient is frequently recommended an easy mode of getting rid of him to give galvanism and electricity a fair trial ; and if they do not succeed, change of air and scene, sea>bathing, or a '* course of waters" at some of the fashionable places of resort for that purpose is prescribed. Despairing of relief from the legalized practitioner, and getting disheartening

b2

4 CAU8B8 09 OPPROBRIUM IN AURAL 8URQEBT.

opinions from men of eminence and repute, we need not wonder that suffering patients throw themselves into the hands of quacks and nostrum-mongers.

Moreover, the difficulties which beset the student in ac- quiring a knowledge of the anatomy of the ear, owing to the ex- ceeding minuteness of the organ itself, the great difficulty of dissecting it, from its depth, the complexity of its structure, and the small, hard bone in which it is placed, as well as the number of crabbed names attached to its different parts, all of which have made it a sort of anatomical crux, which no one wishes to remem- ber longer than the day after he has passed his examination, have conduced not a little to strengthen the belief in the doctrine pro- mulgated by his instructors, that little or nothing could be done to reach the diseases of so delicate and intricate an organ.

Now, notwithstanding the remarks which we hear daily in society, or which we meet with in the periodic and " manual** li- terature of the day, that the treatment of diseases of the ear is an opprobrium to medicine, the progress which this branch of medical science is making is in all probability as rapid as that in any other department of the healing art. Among the many causes from which this opinion has arisen, there are two which must pre-eminently attract the attention of any person conversant with the subject, or who will calmly examine into the question. The first is, that heretofore the treatment of those diseases has been committed to the hands of the most uneducated quacks and charlatans, male and female, persons totally unacquainted with the first rudiments of medical knowledge ; the second, that me- dical men themselves most astute and practical physicians and surgeons in all other respects treat diseases of the ear certainly in a manner that savours of empiricism, by prescribing nostrums, of both a local and general character, which we know they would never think of using in similar forms of disease in any of the other organs of the body. This latter cause evidently results from want of proper attention to the subject in our schools, and from the practice of prescribing at random for diseases, the diagnosis and pathology of which are generally unknown.

INDIFFERENCE OF PATIENTS. 5

To both these causes may be added others that, to a certain degree, serve to bias the public mind against the treatment of aural diseases. In many cases, there is either an unconsciousness of the insidious approaches of deafness, or an unwillingness to admit even the possibility of such an occurrence ; or, again, there is an apathy, to a greater or less degree, on the part of those af- fected with deafness, and a delay in seeking advice, which is scarcely credible. Persons who, if they suffer the least inconve- nience in any of their functions, or the slightest interference with the due exercise or healthy condition of any of the other organs of sense, would immediately apply for medical relief, and submit to any, even the most severe form of treatment, will patiently permit the sense of hearing to be greatly impaired, nay, even lost on one side, without making any effort for ift restoration. When the lapse of months, and even years, have contributed to confirm disease and render such persons incurable, they generally respond to inquiries with regard to previous treatment, that they did not like to be '* tampering** with their ears, or, that they were told no- thing could be done for them.

It would in no wise conduce to the practical effect to which I hope this work may tend, to inquire into all the causes of these results: I may, however, mention, that medical men themselves have in part conduced to produce this want of faith on the part of the public, either by direct opinion as to the incurable nature of the disease or diseases known by the symptom of deafness, or by such futile treatment as broke down the confidence of the pa- tient in any remedy for diseases of the organs of hearing. It is true that cases of what are termed ** nervous deafness,** that is, of defect in the hearing function of the acoustic nerve in any part of the internal ear, from paralysis or other causes, or of those por- tions of the brain which preside over the faculty of hearing, or give origin to, or are connected with the portio mollis of the se- venth pair of nerves, in fact, such cases as are analogous to amaurosis, are as intractable as that disease of the eye; yet I fear not to reiterate the assertion which I made upon several for- mer occasions, that if the diseases of the ear were as well studied or understood by the generality of practitioners, and as early at-

6 THE EARLY HISTORY OF AURAL SURGERY,

tended to, as the diseases of the eye, it would be found that they were just as much within the pale of scientific treatment

We have now several special works upon aural surgery, as well as some valuable monographs thereon in the cyclopaedias and periodicals, yet it is to be regretted that the modem systems of surgery contain but scanty information upon the subject of dis- eases of the ear. The following passage from M. Druitt's well- arranged " Surgeons' Vade Mecum** (which is an exception to the class) is so apposite to the foregoing observations, that I in- sert it: *' Deafness is so common and so distressing an infirmity, and, when of long standing, is so incurable, that we cannot too strongly urge all medical practitioners to make themselves fami- liar with the treatment of diseases of the ear. They should also encourage their pati<!hts to apply to them for the relief of Mffht and indpierU ailments in this organ, instead of allowing them to go on till they become permanently deaf, and then letting them fruitlessly seek relief from ignorant and mercenary quacks.**

THE EARLY HISTORY OF AURAL SURGERY.

In the present day, when literature in every Protean shape and form has compassed the land, and knowledge may truly be said to run to and fro throughout the earth ; and when the polyglot cyclopsedia of the Press has outstripped in the race all other feats of human prowess of the nineteenth century, it might be deemed unnecessary to follow the old school system of detailing the early history of that particular branch of medicine of which this essay treats, were it not that in an art but just emerging from the dark- ness, ignorance, empiricism, prejudice, and superstition, which is to a certain extent even yet the condition of aural surgery, its history not only becomes interesting, but practically instructive. Furthermore, as this work is not put forward as a system contain- ing a compilation of opinions, or abounding in extracts and refe- rences, but is chiefly the result of my own experience, the follow- ing notices of the writings of others is given with a view of directing the student to tlie most accessible sources of infor- mation on the subject.

FBOH THE TIHEB 01 KIPPOCBITES XO CEISUB. 7

I might, with the generality of writers upon the history of medicine, commence with the timea of Hippocrates, for he makes several allusions to the affections of the organs of hearing, not, however, &a idiopathic forms of disease, but as symptomatic of other maladies of an acute or chronic nature ; but it must be borne in mind that at that period of medical science (and, I regret to add, that it has in a great part descended to the present day) the affections of the ear, whether functional or organic, were spoken of, lectured on, written of, and described, not according to the laws of pathology which regulate other diseases, but by a single symptom, that of deafness. " If," says Dr. Kramer, " I mention that the treatment of deafness (viz. as it occurs as a func- tional disorder only of the ear, without any perceptible external alteration of the organ) merely consists of not washing out the ear, but cleansing it with wool, dropping in oil, directing the pa- tient to walk out, rise early, drink white wine, abstain from salads, and allowing him to eat bread, and such fish as inhabit rocky shores, I shall have collected all that is of most importance to give an idea of acoustic medicine at that time."

To CelsuB, the successor of Hippocrates, we are indebted for the first acknowledgment of the specific or independent forms of aural disease; for having introduced the practice of ocular in- spection of the auditory canal ; and for some general rulee for the treatment of the inflammatory affections of the organs of hearing. But this advance in aural medicine, which we owe to Celsus, is more than counterbalanced by his introduction into practice of those stimulating nostrums which were then, and have been since, applied to the membrana tympani without discrimination; and many of which are mode use of in the present day.

Gralen followed in the track of his great predecessor, and although he advanced somewhat in symptomatology, and was evidently better acquwnted with the causes of the inflammatory diwases of the ear, yet he and his disciples so increased the num- ber of remedial agents which were applied to the external meatus, that we find aural medicine and surgery, toward the end of the fifteenth century, but a collection of hard names, unconnected symptoms, fanciful and absurd theories based on causes the most

8 WBITIH08 09 THB EARLY IEI8H PHT8ICIAV8.

improbable, and a category of medical subetances from the ani- maJ, mineral, and vegetable kingdoms, principally, however, composed of hot spices and stimulating applications, of which I may mention castor, ox-gall, garlic, frankincense, opium, nitre, euphorbium, alum, iron filings boiled on vinegar, hellebore, myrrh, and many other such substances, each lauded by their respective admirers, and extolled as panaceas for deafness in all its numerous forms and modifications; as we find glycerine is at the present day. Those who still prescribe such nostrums, and they are many, might consult with advantage old '* Gbtbelhover's Boocke of Physicke," printed in 1559.

It would afibrd us neither literary interest nor practical utility, commensurate with the task, to detail the notions concerning the treatment and diseases of the ear, as they may be found scattered throughout the writings of Aurelianus, Paul of JEgina, Razes, Serapion, Hali Abbas, Mesue, and Dioscorides; the works of the three latter of whom were translated into Grselic by several distin- guished Irish physicians from the beginning of the fourteenth to the end of the sixteenth century.*

At the conclusion of the fifteenth century the anatomy of the ear received a new impulse, by the investigations and discoveries of some of the most distinguished anatomists and physicians of that age, in compliment to whose labours subsequent writers gave those parts names which we retain to the present day, as, the tube of Eustachius, the aqueduct of Fallopius, the liquor of Cotunno, and the fissure of Casserius ; but although these celebrated men made the worid better acquainted with the anatomy of the organ of hearing, and thus removed one of the chief obstacles to the in* vestigation of aural pathology, their successors in medicine ad- vanced but little in the diagnosis and treatment of diseases of the ear.

The first special work upon the ear that I have been able to discover is that of Heumius Mercurialis, ** De oculorum et aurium

* See the author't Introduction to the memoir on Vital Statistics in the Census of Ireland for 1841 : and also a Lecture on the Early History of Irish Medicine, deliveied at the College of Physicians, and published in the Medical Gazette fbr 18th February, 1848, et 9tq.

FIRST INSTRUCTION OF THE DEAF AND DUMB. 9

qffeetibw Prcdectiones^^ the first edition of which was published at Frankfort in 1584. Mercurialis was chiefly a compilator from the works of the Greeks, Romans, and Arabians, and as an origi- nal investigator deserves no credit ; but he collected all that was known and had been written before his day on aural diseases ; the little he did add was that of a few more nostrumSf and, therefore, he may be consulted with advantage by those of the fraternity who still adhere to the good old rule of applying such remedies as hot onions in acute inflammations of the meatus or tympanum.

In the sixteenth century the attention of philanthropists was first turned towards the lamentable condition of the deaf and dumb. Prior to that period, during those ages wont to be called enligh- tened, and in those countries styled civilized and even refined among the Egyptians, Greeks, Romans, and Hebrews, the deaf mute was, and even still in the Orient is, but little removed from the brute, and is often employed for the basest and most de- grading o£Sce8, such as humanity in the present day, in this coun- try at least, shudders at. Up to that period the deaf and dumb were not considered susceptible of improvement or instruction of any kind, and their very passions, unrestrained by any influence, human or divine, were frequently made to minister to the cruelty or sensuality of those around them. I need not further enlarge upon this subject here, as it is considered at length in the section of this work devoted to deaf-dumbness.

The first book that treated of our subject in the seventeenth century was a posthumous Latin work of Joseph Heurnius, on the diseases of the organs of hearing, published by his son, the cele- brated Otho Heurnius, in 1602. Lincke, however, says that he was but a compiler. Heretofore the treatment of aural diseases consbted, as already remarked, for the most part, in medicinal agents and empirical nostrums; but in 1646 the principles of sur- gery were brought to bear upon this class of afiections by the master-mind of Fabricius von Hilden. His observations on the extraction of foreign bodies, on polypi, and other diseases of the external auditory conduit, are well worthy of perusal ; and to him is generally ascribed the invention of the first speculum auris, as well as the first ear instruments on record. His speculum was

10 LABOURS OF FABBICIU8 AMD DU VERVBT.

formed on the principle of the common forcepe-like instrument still in use ; but from the following passage in a still older writer, Peter do la Cerlata, '* per inspectionem ad aoUm trohendo amrem et ampliando cum speculo aui alio imtrumenio^ we are led to be- lieve that means were employed before his time for examining the external auditory passage. Instruments of this kind, and for this purpose, having been once recognised and employed by prac- titioners, have since been variously modified, according to the in- genuity of the inventor ; ^yet their first introduction into practice decidedly formed an epoch in aural surgery. Fabricius's obser- vations, and the description of his instruments, will be found in his " Opera Omnia."

The next work of any merit that appeared in connexion with aural medicine was published by a Genevese anatomist, Theophi- lus Bonet ; his observations, as they are set forth in his great work, the *^ Sepulcretum vel Chirurgica Practicay^ were chiefly confined to the pathology of the ear from dissection ; but in a practical point of view he advanced little beyond the limits attained by his predecessors.

Towards the conclusion of the seventeenth century aural sur- gery received a new impulse from the talents and laborious in- vestigations of the distinguished French anatomist, Du Vemey. Of late it has become the fashion to decry the labours of this great man in my humble judgment, unjustly for he was far in ad- vance of his time, and although the pathological is not as volumi- nous, nor perhaps as accurate as the anatomical part of his writings on the organ of hearing, still he was a lucid painter, and a gra- phic describer of disease. He was the first person who arranged the diseases of the ear according to the anatomical structures af- fected, as, into those of the outer ear and meatus, those of the mid- dle ear or tympanum, and those of the internal ear or labyrinth. From the times of £ustachius to the period on which we are now engaged, we have no work upon the anatomy of the organ of hearing equal to that of Du Vemey, and to this day it may be consulted with advantage. Wo likewise are indebted to Du Ver- ney far more than is generally acknowledged, or, perhaps, writers are aware of, for having given the first impulse to anything like

EUSTACHIAN CATHERBTISM BT OUYOT. 11

a knowledge of aural anatomy and surgery in England ; for his book, which was published in Paris in 1683, was translated into English after his death, and published in London in 1737, being thus, though a translation, the first special treatise in point of time upon aural medicine or surgery in our language. This is now very scarce, yet there can, I think, be little doubt but that Mr. Saunders availed himself largely of it. However, to Du Ver- ney, and not to Lallemand and Itard, we are indebted for the pre- judice that up to this day exists with regard to the treatment of otorrhoea. But the latter were the more reprehensible, as from the age in which they lived, and the giant growth of medical know- ledge subsequent to the time of the former, they should have known better ; but I believe, like many modern practitioners, they chose rather to transmit the prejudices of one hundred and fifty years before, than take the trouble of investigating for themselves.

Without entering minutely into the history of aural medicine during the latter part of the seventeenth century, which, after all, would consist in the enumeration of the Latin writings of various Continental authors, more curious than instructive, let us pass on to the penultimate century of our own period, when aural medi- cine first dawned in Great Britain.

Li 1713, Peter Kennedy published in London a little work styled " Ophthalmographia, or, a Treatise on the Eye,^ to which is added an Appendix of some of the diseases of the ear, wherein is observed the communication between these two organs; the latter part consists of about ten pages.

It is remarkable, that the discovery which Eustachius made of the tube which bears his name had no practical influence upon this branch of medicine, and that for nearly two hundred years surgery made no effort at availing itself of this knowledge, for the purpose of remedying diseases of the ear. Li 1724, M. Guyot, a postmaster of Versailles, proposed to the Parisian Academy of Sciences to inject the Eustachian tube, by means of a catheter in- troduced through the mouth, for the removal of obstructions in that canal, and also in the middle ear. It seems, however, that the French academicians were not sufficiently aware of his valu- able discovery, or at least proposal, for it is a question whether he ever performed the operation himself

12 BH0LI8H AU&I8T8 GLBLAHD.

In 1741, Archibald Cleland, an English army surgeon, pub- lished in the Philosophical Transactions an account of ** instru- ments proposed to remedy some kinds of deafness, proceeding from obstructions in the external and internal auditory passages.** The first of these consisted *' of a convex glass, three inches in diame- ter, fixed in a handle, into which is lodged some wax candle^ which when lighted will dart the collected rays of light into the bottom of the ear, or to the bottom of any cavity that can be brought into a straigfu liner Insignificant and incomplete as this instrument of Cleland undoubtedly was, it is, nevertheless, deserv- ing of our attention, inasmuch as to it may be traced the subsequent inspector auris of Deleau, of Itard, Buchanan, and Kramer. The principal object of Cleland*s inspector for throwing a stream of artificial light into the meatus was for the purpose of discovering the presence of hardened cerumen, which he removed by means of a jet of medicated steam, ** but if,** says he, '* this has not the desired effect, and the person still remains deaf, the following in- struments are made to open the Eustachian tube; if upon trial it should be found to be obstructed, the passage is to be lubricated by throwing a little warm water into it, by a syringe joined to a flexible silver tube, which is introduced through the nose into the oval opening of the duct, at the posterior opening of the nares, towards the arch of the palate.** This catheter had affixed to it a shecp*s ureter, to the other end of which was attached the syringe, ** whereby warm water may be injected ; or they will admit to blow into the Eustachian tube, and so force the air into the barrel of the ear, and dilate the tube sufficiently for the dis- charge of the excrementitious matter that may be lodged there.** He likewise used probes, of the same size as the catheters, to ex- plore the tube. Cleland was either unaware of, or disbelieved, the account of Gxiyot*s having introduced an instrument into his own Eustachian tube through the mouth, nineteen years before ; for in his essay in the Philosophical Transactions he does not once allude to the circumstance. To the English surgeon, however, is un- doubtedly due the merit of having first introduced a catheter into the Eustachian tube through the nose, the only certain way, I believe, of performing such an operation.

In May, 1755, Mr. Jonathan Wathan published a more de-

JONATHAN WATHAN. 13

tailed essay in the Philosophical Transactions, on ** a method proposed to restore the hearing when injured from an obstruction of the tuba Eustachiana. This gentleman, who seems to have been a good practical anatomist, as well as a dexterous surgeon, had an opportunity of making a post-mortem examination in a case of deafness, wherein it was found that both Eustachian tubes were " stuffed quite full of congealed mucus.** If Cleland over- looked, or was unacquainted with the proposed operation of the Versailles postpaaster, Wathan seems to have completely over- looked the more recent and effectual discovery of Cleland; but in allusion to the post-mortem examination to which I have just re- ferred, he says, in the commencement of his very admirable essay : ^* As all these concurring circumstances strengthen me in my opi- nion, they likewise incited me to make trial of an operation that was some time ago proposed to the Academy of Sciences by M. Guyot, but the author having never practised it, he wanted the recommendation of facts to support and enforce it, it was, there- fore, rejected by them as impracticable.** And in a note, he adds, that Ghiyot having recommended the introduction of it through the mouth, which is quite impossible, *' Petit proposed, and that learned and skilful anatomist, Mr. John Douglas, first demonstra- ted the possibility of passing the probe through the nose into the Eustachian tube, and to him I freely acknowledge myself indebted for the hint.** The catheter used by Mr. Wathan was not much larger than a common-sized probe, and was bent a little at the end, very nearly in the same form as that used by Kramer, the distinguished Prussian aurist; and with this and a syringe he in- jected and washed out the Eustachian tube and middle ear. There can be no mistake about the mode of Wathan*s proceeding, for he has given a very good representation of the operation in a plate attached to his essay in the Philosophical Transactions.

I have dwelt thus long upon the introduction of instruments into the Eustachian tube, as that operation formed the second, and, perhaps, one of the greatest epochs in the history of this art, because the merit is due to our own countrymen, and because the English works upon aural surgery are not sufficiently explicit upon this point, and many of the Continental ones are altogether

14 CAUSE AKD PBCULIAR1TT OF SHORT HEARING.

uninformed with regard to it,— Dr. Kramer, in his critical literary review, being under the impression that Guyot had really intro- duced the catheter through the mouth.

The essays of Cleland and Wathan, imperfect as they were, were decidedly the greatest addition to aural surgery made in the eighteenth century, and had the discoveries and valuable obser- vations of these practical men been followed up in England, it is probable we would now be far in advance of our Continental neighbours. I would strongly recommend a perusal of Wathan*s paper, as the cases he describes are most valuable in the diagno- sis of obstruction of the Eustachian tube.

So early as 1842 I was familiar with, and have since frequently pointed out to many of my medical friends and pupils a peculiar form of deafness, in which the mcmbrani tympani had fallen in towards the inner wall of the middle ear, had lost much of its vibratory power, and in which, wlien examined under a good light, the handle of the malleus may be seen appearing to press outwards in strong relief. In this affection, which, I have reason to believe, is very often mistaken for nervous deafness, we have what may be termed short hearing^ from an alteration in the vibratory mem- brane of the car, in like manner as we have short riffhtedness^ or myopia, sometimes arising from a peculiar alteration in the curve of the cornea. I find, however, upon carefully perusing the pa* per of Cleland, that he had some idea of what I have here de- scribed, and of its being produced, as I have known it to be in some cases, by accident. *' There is,"" he says, " another kind of deafness, which proceeds from a violent clap of thimder, noise of a cannon, or the like. In this case it is probable that the position of the membrana tympani is altered, being forced inwards upon the small bones, and so becomes concave outwardly. In this case no vibration of sound will be communicated to the drum until the membrane has recovered its natural position."*

During the remaining half of the eighteenth century I have little to record ; the art does not appear to have advanced a single step, either in Britain or any other part of Europe, Books and

* Philosophical Transactions, vol. xll. part ii. p. 850.

THS GERMAN AND FBENCH SCHOOLS. 15

essays were written, no doubt, but their authors added little to the labours of their predecessors. The great majority of these writings emanated from the German press, as, for instance, those of Gniditsch, Wildberg, Milloradovics, Kritter, Amemann, and Lentin. Of the French school may be mentioned Desmonceaux and Leschevin ; the writings of the latter will be found in the Memoirs of the Royal Academy of Surgery of Paris for 1763. Having lately had occasion to examine this dissertation, which was undoubtedly the best of its day, I am bound to say that the lavish praise bestowed upon it by the French, and the severe criticisms of the German writers, within the last few years, were alike unmerited.

Up to the close of the eighteenth century no special work upon the diseases of the ear had appeared in England, with the exception of the translation of Du Vemey, to which I have already alluded. English works have, it is true, been enumerated by foreign writers, but they were not written upon the diseases, properly so called, but on the congenital defects of the organs of hearing. These I have specified in that portion of the work re* lating to the instruction of the deaf and dumb.

In 1788 Dr. Peter Degravers, who styled* himself Professor of Anatomy and Physiology, published in Edinburgh '' A Treatise on the Human Ear,** as an Addenda to the second edition of his ^* Physico-Medical and Chirurgical Treatise on the Human Eye." This tract consists of 62 pages, and is divided into three Parts: The Anatomical Exposition ; The Physiological Inquiry into the Origin of Sounds ; and the external and internal Disorders of the Ear. The work, though very much beneath that of the author^s Observations on the Diseases and Operations of the Eye, is yet intelligible enough, and came up fully to the state of knowledge on aural surgery at that time. It is generally believed that Sir Astley Cooper was the first person who perforated the membrana tympani. Degravers, however, tells us in his essay that he com- pletely removed the tympanal membrane in one case ; and again he says : *' I incised the membrana tympani of the right ear with a sharp, long, but small lancet. I left the patient in that state for

16 SIMS AND THE LOKDOH MBDICAL 80CIBTT.

some time, and afterwards observed that it had re-united

I incised again the membrani tympani of the right ear but eniciallj ; and on removing the parts of the membrane incised, I discovered some of the ossicula, which I brought out."

During the eighteenth century the anatomy of the organ of hearing was further studied by Valsalva, in his work ** De Auie Humana Tractatus,** published at Bonn in 1704 ; and by I. F. Gas- scbohm, whose book, ** Tractatus Quatuor Anatomici De Aure Humana, Tribus Figurarum Tabulis lUustrati,** appeared in 1734. These writings, with subsequently those of Scarpa, Soemmering, and, in later times, of Arnold, have rendered the anatomy of the organ of hearing very complete. Mr. T. Wharton Jones has embo- died all that was known upon the subject when he wrote the arti- cle ^' Organ of Hearing** in the Cyclopaedia of Anatomy in 1838.

The members of the Medical Society of London, instituted in 1773, and composed of the physicians, surgeons, and apothecaries of that time, were not insensible to the low condition in which aural medicine stood toward the end of the last century, and in their valuable memoirs will be found some scattered notices upon the diseases of the ear, from the pens of the president. Dr. Sims, as well as from Mr. Houghton, Dr. Zeucker,