PART I, (Part 2)

Esq., contributed to a great cyclopaedia an ar- ticle on the organ of hearing, which comprised all that was known up to that time, and which is a very valuable mono- graph for reference^ 1821-51] We are now, in our review of the investigations of the anatomy of the ear, down nearly to our own time ; and we come to the familiar names of Huschke, Ar- * Philosophical Transactions, 1800. The Croonian Lecture, f Vol. x., 1832. % Mr. Wilde on the early history of Aural Surgery. Dublin Medical Journal, 1844, p. 441. § Cyclopaedia of Anatomy and Physiology. Edited by Robert B. Todd. 26 A SKETCH OF THE nold, Sclilemn, Johannes Mutter, Breschet, Bonnafont, and Toynbee. 1851] Toynbee* investigated anew the membrana tympani. He especially added to our knowledge in regard to the fibrous layer, and described, for the first time, the dermoid layer. This paper was published in the Philosophical Trans- actions. It was preceded by papers in the Medico-Chirur- gical Transactions, on the pathological anatomy of the ear, papers which have given Toynbee lasting fame, because they did very much to place otology upon as sound a basis in pathology as they had been placed in anatomy by the labors we have enumerated. Toynbee s statement, that the Eustachian tube was usually a closed canal, and that muscular action was required to open it, led to Politzer's method of inflating the ear, of the value of which procedure more will be said in our review of the pro- gress in therapeutics. 1856] Von Troltsch began a series of anatomical investiga- tions, which, we may hope, have not yet ended. His contributions relate to the structure of the membrana tympa- ni, the muscles of the Eustachian tube, and the pathological anatomy of the middle ear. He also, in the course of some investigations of the cavity of the tympanum of the foetus, found that it was filled with a proliferation of the mucous mem- brane of the labyrinth wall, which forms a mucous cushion, that rapidly lessens in size after birth. This anatomical fact explained the frequency of inflammations of the middle ear in young children. 1858] Gerlach f followed Toynbee in the investigation of the fibrous layer of the membrana tympani, and showed that in the extreme periphery the circular fibers were wanting. 1860] Magnus investigated anew the articulations of the ossicula, and showed that there was no real joint be- tween the malleus and incus. He also denied the voluntary or involuntary contraction of the tensor tympani muscle. 1862] Politzer and Lucas published the results of expert * Diseases of the Ear. American edition. f Schwartze, Archiv fur Ohrenheilkunde. Bd. I. PEOGEESS OF OTOLOGY. 27 ments, which were supplementary to those of Miiller, in show- ing that the origin of a certain crackling sound in the ear war; not in the tendon of the tensor tympani, but in the Eusta- chian tube. 1851] Corti* an Italian anatomist, reviewed the work of his countrymen of the former centuries who studied the cochlea, and divided the lamina spiralis membranacea into two different broad zones — an inner one, Zona denticuhta ; and an outer, Zona pedinata. He described some peculiar bodies as teeth, which soon got the names of Corti s organ, and which were subsequently found to be the termination of nerves. Claudius, Bottcher, and Better followed Corti in investiga- tions of this part, which will be fully noticed in discussing the anatomy of the internal ear.f 1858] Hyrtl, an anatomist of great industry and reputation, made an important discovery of the frequency of a thin and porous bony covering to the roof of the cavity of the tympanum, thus elucidating some cases of cerebral disease arising from affections of the middle ear. Our review now extends to the time of the publication of the Archiv and the Monatsschrift fur Ohrenheilkunde, as well as to that of the American Journal ; the Archives of Oph- thalmology and Otology ; to familiar ground, in the knowledge of which the subsequent pages are written. PEOGEESS IN AUEAL THEEAPETTTICS. In the earlier ages the progress in the treatment of the ear by no means kept pace with the advance in the knowledge of its anatomy. While the structure of the organ was sufficiently well understood to cause the investigation of its diseases to be both interesting and profitable, the treatment was crude and illogical, unworthy of the knowledge which should have been its basis. Herodotus! says that there were specialists in Egypt, a par- * A Manual of Histology by Strieker, p. 1054 (Translation), f For the material for the sketch of the preceding page, I am indebted ta Schwartze, Archiv fur Ohrenheilkunde. Bd. I. \ Herodotus, translated by Cary. Euterpe, p. 125. 28 A SKETCH OF THE ticular physician for each disease, but no mention is made of aurisfcs. " The art of medicine is thus divided amongst them : each physician applies himself to one disease only, and not more. All places abound in physicians ; some physicians are for the eyes, others for the head, others for the teeth, others for the parts about the belly, and others for internal diseases.'' Although Hippocrates knew very little about the anatomy of the ear, he speaks at some length of the causes of aural disease. For many of these he must have drawn upon his imagination. They were very comprehensive, and may prop- erly be said to explain almost anything. They are such as heat, cold, dryness, moisture, the blood, mucus, and the yel- low and black bile. Hippocrates considered internal inflammation of the ear as essentially an inflammation of the head. He described as a very dangerous disease, pains in the ear, connected with high fever, and if neither pus escaped from the ear nor blood from the nose, the death of the patient usually occurred from the ninth to the eleventh day. This was probably the disease that we now name acute ca- tarrh of the middle ear, and the great medical philosopher was certainly right in calling it a serious one. Among all the improper remedies which Hippocrates recom- mends to be dropped into the ear, there is one good one, al- though it is very simple, which is often thought to be a sugges- tion of our own day ; that is, the instillation of warm water, which the great physician advises to be done by means of a sponge. If this simple, but often efficacious, treatment were universally practised in cases of acute inflammations of the outer and middle ear, it would alleviate a great deal of suf- fering. Hippocrates seems to have had an eye to the effect upon the patient's mind, to use no harsher term, if we may believe that the following passage was not, as Lincke insinuates, in- terpolated* : " If any person has a pain in his ear, the phy- sician should roll a bit of wool about his finger, and then pour some warm oil into the ear, and then taking the wool in the hollow of his hand, and hold it before the ear, in order to * Lincke's Handbucli, Bd. II. p. 5. PK0GEESS OP OTOLOGY. 29 make the patient believe it has come out of it. In order that the deception may be complete, the wool should be at once thrown into the fire." Asclepiades, a friend of Cicero, recommended instillations for the ear, of oil, in which three or four cockroaches, or an Afri- can snail were cooked, while a piece of henbane in oil of roses, or woman's milk, is to be afterwards added. B.C. 44, A.Dt 19] Celsus (Aulus Cornelius) also used a com- posite remedy which was said to be of service in all kinds of diseases of the ear. It was made of cinnamon, cassia, blossoms of bulrushes, castoreum, white pepper, am- monia, myrrh, and saffron, as well as of various other agents. These substances were all rubbed up with vinegar, and diluted with the same agent when used. Celsus, in his treatise De Medicina, spoke in some detail of aural disease. He was perhaps the first to recommend vigor- ous injections of water in order to remove foreign bodies from the ear, although this proper recommendation carries less weight than it would have done had it not been mingled with a great deal of bad advice, which shows that a disposition to use the simplest means for a desired end, is not always connected with great learning. Celsus recommends in obsti- nate cases of a foreign body in the ear, that the patient should be laid upon a table, and upon the side of the affected ear, when the surgeon strikes with a hammer upon the table, in order to dislodge the foreign body by the concussion. Among the mass of writers mentioned by Lincke as being before Galen's time, Archigems seems to have had some cor- rect notions. He practised venesection for severe pain in the ear, and employed purgative enemas, warm baths to the ear, especially by means of a sponge dipped in hot water. He warns against the use of cold water. He also has his method of removing a foreign body from the ear, and recommends a vigorous shaking of the affected head. A child is to be seized by the feet and well shaken, while adults are to be held very much as Celsus proposed ; that is, they are to be laid on a table, while the leaf of it nearest the head is to be repeatedly opened and shut with a slam. Archigenes, like other ancient authorities, however, thinks 30 A SKETCH OP THE very much of instillations of various kinds for the relief of the different forms of deafness. He recommends speaking-tubes to the deaf. A.D. 130-201] Galen recognized the importance of the ear, inasmuch as it lies so closely to the head. Al- though his classifications of disease are very minute, we do not seem to learn much from his writings, except the value of agents that will excite the secretions of the nose and mouth, which he recommends in aural disease. He complains of the empirical practices of his predecessors in ordering now cold and now warm agents, now sweet and now sour ones. He also tells of a poor patient of some less learned, or less practical man than himself, who, in accordance with advice, used black pepper as a local means of treatment for an in- flamed ear, and whose sufferings were so much augmented, that he came near hanging himself. Galen objects to the common use of opium, which seems to have been employed very much in relieving the pain of aural disease. Tinnitus aurium, according to Galen, was due in some cases to exhalations from the stomach, and in others to in- creased sensitiveness of the ears. Both of these causes cer- tainly leave much to be wished for, in the way of exact knowl- edge, as to the nature of this distressing symptom. It would be tedious in the extreme to follow Galen through his classification of diseases of the ear, and remedies for them. Like his predecessors and contemporaries, he was not will- ing to admit that there were some diseases for which remedies were useless, so far as their knowledge went. The aural pre- scriptions of the ancients may well be compared to the mitrailleuse, dangerous far and wide. Ccvlius Aurelianus, a successor of Galen, stands out prom- inently from the absurd theorizers of his time, in his clear delineations of pain in the ear, and his sensible remedies for it — leeches, cups, poultices, mustard-plasters, and so on. Apollonius, quoted by Galen, took out foreign bodies with ear-spoons, forceps, hooks, etc., which were enveloped in wool and dipped in turpentine. He softened ear-wax with saltpetre in vinegar, and then removed it with lukewarm water or oiL PROGRESS OF OTOLOGY. 31 About this time we read of the materia medica of Marcel- lus, who gives us a glimpse of the popular remedies of the day. Frogs' fat is recommended for pain in the ear ; the urine of pigs, of children and men, and the blood of young chickens, for an ulcer in the ear ; for worms in the organ, the saliva of a hungry man, and so on. We see a great deal in the ancient literature, of worms in the ear ; so that we must conclude that they were much more commonly found in the olden time than with us. This was probably due to the fact that cases of neglected suppura- tion were very frequent, and that living larvae were thus often developed. 600 A.D.] The famous surgeon and obstetrician, Paulus jEginita, who flourished in the seventh century, should be remembered as a contributor to the surgery of otology. He expended much energy on the subject of foreign bodies in the ear, a field which has unfortunately always suf- fered from surgeons over-anxious for operations. He suggests a method for their removal, which, when all other means fail, is still to be thought of in our day. It is an incision behind the ear, to detach the auricle from the canal. We are thus enabled to get at the foreign body very readily. Hippocrates is said to have also recommended this procedure. According to Lincke, the Arabians got their knowledge of otology, whatever it was, from the Greeks, of whom Galen was the chief authority ; so that we can only add a few more absurd remedies as their contribution to knowledge : for deafness, the brain of a lion mixed with oil (the brain, not the lion,) is advised by Bhazes. Serapion advises instillation of woman's milk for the cure of ear-ache in children ; and he gives the important caution that if it be a boy who is affected, the milk must be that of a woman who is nursing a female infant. As we have seen, in noticing the progress in our knowledge of the anatomy of the ear, the centuries from Galen to Val- salva were dark ages for our science. Lincke says : " Otol- ogy remained at the same point at which the Grecian, Ko- man, and Arabian physicians had left it." In Lincke's own list of the progress of these centuries we find traces of ignor- 32 A SKETCH OF THE ance and empiricism only. One author named Gadesden rec- ommends that, in cases of inflammation of the ear, one of the lower classes be hired to suck out, by means of a tube placed in the meatus externus, all the morbid material of the ear ; and this is said to be a cure for all kinds of deafness, not even excepting that from a purulent affection of the organ. Lincke believes that Peter de la Cerlata was the first to use a specu- lum for widening the auditory canal for purposes of inspec- tion.* 1560] Johannes Arcularius gave some sensible rules for the management of aural disease. He declaimed, for instance, against the indiscriminate practice of stuffing the ear with cotton; but he advised an extremely peculiar means of extracting a foreign body from the ear. The head of a lizard was to be cut off, placed in the affected ear, and allowed to remain there for three hours. The animal is then to be removed, when the foreign body will be found in its mouth. 1560] Alexander Benedetti recommends, as a remedy for pain in the ear, the semen of a boar, which is to be carefully taken from the vagina of a sow, before she has dropped it upon the ground. This, however, is the suggestion of a writer on general medicine, and not on otology. 1523-1562] Gabriel Fallopius, in this century, seems to be entitled to the honor of having first taught that a discharge of pus from the ear of a child should not be meddled with ; for as Fallopius gravely taught, and as has been gravely repeated by his legitimate successors for two hundred and seventy -three years, this discharge of pus is an effort of na- ture to throw morbid material out of the head through the ear. The otorrhcea of adults, according to Fallopius, is also a discharge from the brain, and should not be treated by astringents, but with mild, cleansing remedies. He used an aural speculum, and employed sulphuric acid to remove polypi. 1600] In the seventeenth century we hear of De Vigo, body surgeon to Pope Julius II., curing his Holiness of a very * The passage quoted to sustain this view is " per inspectionem ad sole~n trahendo aurem et ampliando cum specula aut alio instrumento." PROGRESS OP OTOLOGY. 33 obstinate abscess of the right ear, by means of a mixture, or liniment, of 3 ij of oil of eggs with 3 iij of oil of roses. What kind of an abscess this was, or where it was situated, Linclce does not tell us. In the latter half of the sixteenth century a certain Capi- vacci seems to have deviated a little from the errors of his pre- decessors. He speaks with more precision of aural disease. He describes thickening, ulcers, and cicatrices of the mem- brana tympani, and says that deafness which arises from an affection of the nerve or labyrinth is incurable — a declaration in which his successors, three hundred years after him, are forced to unite. Capivacci also describes a method of making a differential diagnosis between the diseases of the peripheric and of the central parts of the organ of hearing. One end of an iron rod, an ell in length, is put between the teeth of the patient, while the other is placed upon a keyed musical instrument. If he could distinguish the tones produced by the vibrations of the keys of the instrument, his deafness depended upon some lesion of the membrana tympani ; if not, it