PART I, (Part 4)

Dictionnaire des Sciences Medicales." This work was trans- lated into English by Nathan R. Smith, the celebrated Ameri- can surgeon.t 1821] I. M. G. Hard, Physician to the Royal Deaf and Dumb Institution in Paris, also publishes a treatise, which was translated into German,^: and which did much in the pioneer work of clearing up the undergrowth of centuries of neglect. Then followed Deleau, on the diseases of the middle ear and on perforation of the membrana tympani, an operation for which he claimed more than it deserved. 1827] Karl Joseph Beck, of Freiburg, published a Hand- book of the Diseases of the Ear.§ It is a succinct and carefully written compendium of what was then known in this department of science, and has a very good bibliography, with the exception of the fact that the names of English au- thors are very often misspelled. 1833] Wilhelm Kramer, of Berlin, an author who still lives in a vigorous old age, brought out a work which was animated by the true scientific spirit, and which greatly sim- plified the practice of otology. He has since then published a number of volumes. He introduced a valvular handled speculum, that was an improvement upon the very clumsy ones hitherto in use. He * A Treatise on the Physiology and Diseases of the Ear, by John Harrison Curtis, Esq. 3d Edition. London, 1823. ■j- An Essay on the Diseases of the Internal Ear. Baltimore, 1829. % Die Krankheiten des Ohres und des Gehors. § Die Krankheiten des Gehoerorganes. Heidelberg und Leipzig. 42 A SKETCH OF THE also gave us the air-press, by which air or vapors could be introduced through the Eustachian tube into the middle ear. ' In speaking of the practices of his predecessors, the in- tolerance of Kramer's spirit is seen — an intolerance which is painfully manifest in his later works.* In 1860 he speaks of the writings of Hinton of London — a writer whom, I am sure, all my readers will learn to respect, " as in every respect unimportant," while Toynbee's pathological investigations, to which science is so much indebted, are actually treated with sneers. In 1865, Kramer published a monograph, t which is essentially a review in a very unfriendly spirit of the labors of Toynbee, Wilde, Yon Troltsch, Erhard, Voltolini, and others, of whose writings I shall soon speak. What good work Dr. Kramer actually did for otology in his younger days has been overshadowed by his subsequent writings. In spite, of what I am almost inclined to call common sense, he still persists in rejecting the modern method of investi- gation, as well as the results of examinations of ears re- moved from persons who have been deaf. He still con- tinues to use the handled bi-valved speculum, with sunlight as the only source of illumination, and on cloudy days sends away patients without examination ; and because Toynbee made post-mortem examinations of many ears of persons whom he had not seen during life, Kramer rejects all pathological investigations, except experiments conducted upon a dead body or a glass model. He speaks of Politzer's method of inflating the middle ear, " as a miserable resort in cases of necessity, the employment of which, all pompous commenda- tions to the contrary notwithstanding, stamps him who uses it with want of skill in the introduction of the catheter." Again he calls Toynbee, in his work published in 1867,} and this after Toynbee had lost his life in experiments as to the effect of chloroform and hydrocyanic acid, " a very poor aural surgeon." " E-in miserabler Ohren-arzt." , These are fair specimens of Dr. Kramer's style in dealing with an opponent, with any one who claims to have accom- * Okrenlieilkunde der Gegenwart, 1860. Berlin, 1861. f Ohrenkrankkeiten und Ohrenartze in England and Deutschland. % Handbuck der Okrenlieilkunde, p. 44. Berlin, 1867. PROGRESS OF OTOLOGY. 43 plished anything for aural pathology and therapeutics in any other way than by the employment of his catheters, his bougies, and his valvular-handled speculum. In this review of what has been done to bring otology up to its present position, I have been compelled to notice the difficulties with which the advance of the science has been obliged to contend in the way of improper and unjust criticism, from one who, in this country and England, has acquired the reputation of a safe guide and leader in this part of the field of medicine. 1841] George Pilcher wrote an essay on the ear, which re- ceived the Fothergillian gold medal from the Medical Society of London. It is a valuable compilation. The sec- tion on foreign bodies in the meatus is full of warning interest. There is, however, very little of the author's own experience in the volume.* In 1841, a gentleman from New York, consulted Dr. James Yearsley, of London, in regard to his deafness, who informed Dr. Y. that he was enabled to improve his hearing power, so that he could produce in his left ear a degree of hearing quite sufficient for all ordinary purposes. This was done by the introduction " of a spill of paper previously moistened with cotton to the bottom of the passage."t This was the real discovery of the artificial membrana tym- pani, although Dr. Martel Frank, in his cyclopaedic text-book, refers to a means of preventing injury to the ear, but not of improving the hearing when the membrana tympani is lost, which is the use of a silver, gold, or lead tube, the inner end of which is covered by a membrane. The fact that such a means of protecting the ear was used in 1640 has been already alluded to. It cannot be said, however, to be an artificial membrana tympani in the sense of Yearsley's cotton wool, which he soon substituted for the paper of the New York pa- tient, or of Toynbee's disk of rubber attached to a wire. The artificial membrana tympani has proved itself a very valuable * Treatise on the Structure, Economy, and Diseases of the Ear. American edition, 1843. f On Deafness. Yearsley, p. 221. 44 A SKETCH OF THE means of treatment, and is in constant use by many of those who treat suppurations of the middle ear.* Yearsley's book, as its title indicates, " Deafness Prac- tically Illustrated," is not to be rated with the text-books of Wilde, Toynbee, Kramer, or Frank. The work of Dr. Franh,\ already alluded to, will be found a valuable work of reference, although it lacks individuality. Hoffman's (Troltsch's) mode of examining the auditory canal and membrana tympani is fully described by Frank on page 49 of his book ; but he attached no importance to it, not fore- seeing that it was to supersede all other methods, as it has done, as improved and brought into general use by Yon Troltsch. 1843] The work of William B. WiUe,% surgeon to St. Mark's Hospital, which was republished in this country, where it has had a large circulation, and which was translated into German, probably did more to place our science upon a sound basis than anything that has been done in otology since the days of Yalsalva. This work was founded on the obser- vations of a careful observer, who had acquired fine habits of study as a skillful ophthalmologist. It was not, as the works of Lincke and Frank, a cyclopaedia of what had been written on otology, nor was it full of absurd theories like that of Kra- mer, bub it consisted in the application of thorough anatomi- cal, physiological, and therapeutical knowledge to the study of an organ that had been hitherto treated as if it were sui generis, and not subject to the same accidents and diseases, and consequences of those diseases, as other parts made up, in like manner, of integument, of cartilage, mucous mem- brane, periosteum, and bone. In fact, Wilde — now Sir Wil- liam Wilde, in consequence of the well-earned recognition of his Queen — brought otology, or aural surgery as he called this department, down from the terra incognita of the ancients to a point where it could be investigated by the average practitioner, and where it was respected by all. He gave us * Frank, p. 293. f Practische Anleitung zur Erkenntniss und Behandlung der Ohrenkrank- J>eiten. Erlanger, 1845. X Practical Observations on Aural Surgery. London. PROGRESS OF OTOLOGY. 45 the conical specula, reviving a suggestion of Dr. Newburg of Brussels and Ignaz Gruber of Vienna, and drove the unhandy ones of Fabricius and Kramer out of use. More than all, he taught us that the most of aural disease was dependent upon inflammation, and not upon that which was one of Kramer's pet ideas at that time, "nervous disease," whatever that may mean. 1869] Then came Toynbee's book,* which is mainly valua- ble for its anatomical and pathological investigations. It can never take rank with Wilde's book as a useful treatise for the practitioner, indispensable as were Toynbee's labors as an anatomist and pathologist. Mr. James Hinton's supplement has, however, materially improved Toynbee's treatise. 1861] Dr. Anton von Troltsch, of Wiirzburg, published a monograph t upon the anatomy of the ear, in 1861, which he entitled a contribution to the scientific establishment of otol- ogy. It was certainly all that, and something more. While it gave a very simple and complete account of the anatomy, except that of the internal ear, there were many wise sugges- tions in the text with regard to the treatment of aural disease. Von Troltsch showed himself to be what in the eyes of Kra- mer is a reproach, but what is, in those of the profession at large, an honorable position, a disciple of Wilde and Toynbee. He built upon the foundations which the clinical skill of the Irish, and the industrious labors of the English observer had made, and brought otology in Germany into a position which made it an inviting department of labor. His work upon the anatomy contains the results of many original investigations, which will be found in the anatomical descriptions of this volume. 1862] This work on the anatomy of the ear was soon fol- lowed by a text-book upon its diseases,! which had the same scientific characteristics with the monograph upon the anatomy. It has been translated into the English, French, and Italian languages. In this country it met with great * The Diseases of the Ear : their Nature, Diagnosis, and Treatment. Reprint, Philadelphia. f Die Anatomie des Ohres. Wiirzburg, 1861. \ Die Krankheiten des Ohres. 46 A SKETCH OF THE favor, having passed through two editions, and it has given tone to all the otological literature and investigations of its day. Von Troltsch improved and brought into general use the method of illumination first proposed by Dr. Hoffman, of Westphalia, and thus at one step advanced the science very materially. In 1862, the same year that Yon Troltsch issued his text- book, Dr. Adam Politzer, of Yienna, promulgated his method of injecting the middle ear with air, or of inflating the middle ear. It is hard to overestimate the value of this simple pro- cedure, and the benefit to our science and art that its invention caused. The writer can but quote the opinion of an eminent prac- titioner of this city, who in speaking of Politzer's method once said to him : " If a man were to take this air-bag, and travel through the country, advertising himself as an aurist, and blow up all the ears indiscriminately that were brought to him, he would be a very successful quack." Indeed, the effects of this means of treatment, especially in the case of children, or adults who have suffered but a short time from impairment of the hearing, from disease of the middle ear, are often wonderful. 1883] Dr. Julius Erhard published a work upon the dis- eases of the ear, which is a peculiar mixture of truth with error. The book is rather curious and interesting.* In 1864, Dr. von Troltsch, Dr. Politzer, and Dr. Herman Schivarlze, of Halle, issued the first number of the Archiv fur Ohrenheilkuncle, a work which has been regularly continued under their management, and which has formed a true guide to the otological student and practitioner. In 1865 Dr., now Professor, Politzer published a mono- graph upon the membrana tympani, which was translated into English, and published in the United States, by my friends and colleagues Drs. Arthur Mathewson and Homer P. New- ton, of Brooklyn. The frequent use which every recent writer on otology is obliged to make of this valuable mono- graph, is sufficient evidence of its merit. In October, 1867, the first number of the Monatsschrift fur * Klinische Otiatria Berlin. PEOGEESS OF OTOLOGY. 47 Ohrenheilkunde was issued, under the direction of Dr. Volto- lini, of Breslau, Dr. Josef Gruber, of Vienna, Dr. F. E. Weber, of Berlin, and Dr. N. Riiiinger, of Munich. All of these edi- tors have contributed very much to the scientific advance of otology ; while Dr. Ru dinger has probably done more than any anatomist of his day to elucidate the anatomy of the Eustachian tube. His photographic atlas of the ear is a work of permanent value, and one of which the author has made frequent use in illustrating some of the chapters of this work. 1866] Dr. S. Moos* of Heidelberg, issued a practical treatise on aural disease in 1866, and Dr. Oruber,\ of Vienna, one in 1870. Both of these volumes show much original re- search and are worthy of an English translation, which would bring them before a much larger circle of readers. The American Otological Society was established in 1868, and has held annual meetings since, and has published four volumes of Transactions. To these papers the author has had frequent occasion to refer in the preparation of the fol- lowing chapters, and it is believed that they furnish evidence of the high character of the work that has been done by American otologists. No outline of what has been done in the last twenty years for otology would be complete without a reference to the writ- ings of Professor Edward H. Clarke, of Harvard University. Dr. Clarke published a paper on perforations of the membrana tympani,J its causes and treatment, which was probably the best that had been written on this subject. It received a full recognition among foreign authorities. In this article is con- tained a very important sentence, quoted by Von Troltsch in his text-book, a passage full of meaning and warning : " So necessary is a careful attention to the ear, during the course of an acute exanthema, that every physician who treats such a case icith- out careful attention to the organ of hearing, must be denominated an unscrupulous practitioner." Dr. Clarke has also published a monograph upon polypus * Klinik der Olirenkranklieiten. f Lehrbucli der Olirenlieilkunde. % American Journal of the Medical Sciences, January, 1858. 48 A SKETCH OF THE of the ear, which contains very much of value as to the nature and treatment of these products of inflammation.* In 1869, Drs. //. Knapp, of New York, and 8. Moos, of Heidelberg, began the publication of the Archives of Ophthal- mology and Otology, which are issued simultaneously in Eng- lish and German, and which have added much to the scienti- fic interest in otology. The union of the two branches of sci- ence in so valuable a journal has certainly assisted to gain the respect of the profession for the department of otology. Dr. Lawrence TurnouU issued a treatise on the ear in 1872, which more than any other book as yet published exhibits the work done in otology on this side of the Atlantic. Lincke, writing in 1849, regrets that in Germany no clinique for the treatment of aural patients had as yet been organized. Dr. Reiner, he saj^s, had attempted to do so in Munich, but had failed, as had Dr. Lincke in Leipsic ; and we know that Saunders and Cooper had failed in establishing one in Lon- don ; for in 1804, Saunders had an eye and ear infirmary in London, uuder the name of the " New London Dispensary for Curing Diseases of the Eye and Ear." But the aural part was so unsuccessful, that it became necessary to close it to the au- ral practice. John Harrison Curtis, in 1816, was more suc- cessful, and when Lincke wrote, his dispensary was still carried on. In 1828, the New York Eye and Ear Infirmary, which had been in existence eight years, treated 91 cases of diseases of the ear, to 925 of diseases of the eye. That institution, ac- cording to its last published report, treated more than 2,000 aural cases, while every large city of Europe and America now enjoys the benefits of institutions where aural diseases are properly and specially treated. The striking want of success in the treatment of aural dis- ease was due to the fact, that as yet no simple means had been found for examining the membrana tympani and audi- tory canal. Besides this, the pharynx was not recognized as the point of origin of the most of aural diseases, and there was not a simple means of opening and treating the Eusta- chian tube. All these difficulties have been removed in the * Observations on the Nature and Treatment of Polypus of the Ear. Bos- ton, 1867. AUTHOEITIES. 49 nineteenth century, and in many details of treatment great ad- vances have been made, which render the care of aural disease quite as satisfactory as that of any other of human ills. This is not altogether due to the fact that so many new truths have been discovered, but much of the gratifying change has re- sulted from the sweeping away of the webs of error. In concluding this introductory chapter, the author begs that the reader will bear in mind,