A treatise on the physiology and diseases of the ear; containing a comparative view of its structure and functions, and of its various diseases, arranged according to the anatomy of the organ ...

Front matter

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Introduction

Tur improvements in Medicine and Surgery of late years have been great and important, but more particularly in the latter. In proportion as civilization advances in every state, the number of diseases is augmented, and the profession acquires greater respect and estimation from its more extensive utility. |

In former times, Surgery, the most ancient branch, (for external accidents in savage life always precede internal disease) was simple, and of limited extent. As improvement took place, this department became gradually enlarged; and in point of science and principle, as it is now culti-

Vill vated, it stands on a firmer basis than medicine. For the benefit of society, it has been subdivided, by its professors, into various departments ; which, by calling for a more minute attention to particular subjects, has enlarged our views of them, and made us more capable of affording effectual relief, under circumstances formerly considered as beyond the reach of the Healing Art.

~ One circumstance that retarded the progress of surgery for some time, was the cultivation of anatomy by the early physicians; as witness, the great and invaluable discovery of the immortal Harvey, in the circulation of the blood, which entirely changed the system of medicine at that time; the discoveries also of Glisson, and others of the earlier physicians, tended to promote this end. The physicians preix sided at that period in the dissecting room, and of course took a lead in whatever regarded surgery, as well as medicine; - but the increase of clinical practice to the physician induced him, in time, to lay aside his attention to the dissecting room. As soon as that took place, it naturally fell into the hands of the surgeon, to whom it was at last solely consigned. ‘The moment the surgeon acquired this pre-eminence, by the field of anatomy being left to himself; that moment, what was hitherto regarded as little better than a manual art, expanded in its turn into an extensive branch of science, and admitted divisions equally numerous, and varied, as those which had hitherto been confined to the department of medicine. : |

The consequence of this has been that surgeons, anxious to improve that part of the profession assigned them, have, many of them of late years, limited their practice to certain portions or to the diseases of particular organs; a circumstance which has been of the highest utility to the interests of the community. Though, on this point, surgeons have chosen to be divided in opinion, it is more, perhaps, from self-interest than from doubt of its utility; for every division clearly simplifies, and where a subject is extensive and complex, simplicity and perfection on any one point can never be obtained in any other way.

This minute division of surgery first began with the diseases of the teeth, which certain individuals exclusively treated under the name of dentists, and who form now a numerous and respectable body of practitioners.

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It was next followed by others, in a similar exclusive attention to the diseases of the eye, under the name of oculists; an organ which, from its nice structure and the delicacy and minuteness of its parts, requires both a skilful hand for the treat- | ment of its diseases, and also an accurate and profound knowledge of its anatomy. —

The perfection these branches have acquired is the best proof how appropriately this division has been made, from which the greatest public benefit has accrued: for the advantage which has resulted to mankind from the exercise of the oculist’s profession, as a distinct branch, is incalculable ; the operations on that delicate organ, the eye, are now conducted with a nicety and success unknown in former times; the formation of an artificial pupil, as first invented by Mr. Gibson of Manchester, and

Xi subsequently improved by the late Mr. Saunders, and others, has saved the sight of numbers, on whom former operations had failed, and who, without this discovery, must have continued in total darkness for life.

The same happy result to society has been the consequence of the profession of the dentist. The teeth are essential to the appearance and symmetry of the countenance; without them, that contour and — harmony of features, which the face ought to possess, is wanting; but the teeth are parts of the body which nature has intended should more quickly decay than the other parts, from their greater exposure to external causes, acting upon, and destroying their enamel, and osseous structure. When lost to the constitution, not only is the beauty of the visage impaired, but the process

XU of digestion becomes imperfectly carried on, the food is no longer comminuted as it ought to be, and stomach complaints, with a decay of general health, are too often the consequence.

The hand of the artist has here been the assistant of nature; the artificial substitutes are equal in their effect to the real organized productions originally implanted : nay, to such perfection has the art of man been carried, that in cases of certain complaints, where the palate or bony arch of the mouth has been destroyed, and the unhappy sufferer has been incapable. of uttering and articulating, so nicely has mechanism supplied the defect, that no trace of it can be perceived, either in the articulation, or in the reception of food.

These facts demonstrate clearly the advantage of subdividing the objects of pro-

XIV fessional pursuit or study, and bending a close attention to one point ; it is applying to medical science that which experience has proved to be so successful in the mechanical arts*.

If we take, for example, the construction of a watch, there are no less than twelve different and distinct departments in its manufacture, and it is only by each department having but one wheel or other appendage to do, that this useful article is brought to its great exactness, perfection, and cheapness. ‘The same plan is extended to all the leading branches of manufacture

* This plan of subdividing its subjects has been long acted upon, also, in another liberal and scientific profession, the law, with much advantage. The counsellor, who stands on the same footing as the physician, often limits his practice to particular courts. The inferior departments are extensively branched out into numerous divisions, to give clearness, perfection, and despatch to the various and complex subjects, of which law, as a branch of science, consists.

XV in this country, of which our manufacturing towns afford the most striking examples; and it is a system, the utility of which has | been strongly enforced and reasoned upon by the late celebrated Dr. Adam Smith, in his “ Wealth of Nations.’ Indeed this subdivision and minute attention to one branch may be considered as the great safeguard of the manufactures of this country: perfection and cheapness are united by it in a most eminent degree, which will stand against the rivalship of any other nation, till the same extent of population is employed as in this country, and of course the same perseverance to one object ; this is a fact which no reason can refute, and the principle of it is interwoven with our very nature, _

The mind ofsaman; it is clear, though capacious and possessed of very extensive

XVI powers, cannot embrace the whole circle of science, or retain it with that exactness which is necessary to excel; he must select a part of the circle, if he wishes to shine, and must bend his attention to that subject alone, in scientific pursuits *. However, I do not intend, by this observation, to convey an idea, that the student should endeavour to get acquainted with the department he selects only as a mechanical art, or that he should not travel beyond its bounds: on the contrary, a professional

* A memoir of the author will be found in the European Magazine for April, 1819, which will show he enjoyed the most ample opportunities of medical improvement. First, under his father, an eminent physician in the country, and brother to the late celebrated botanist, Mr. W. Curtis, and next under the different lecturers of the metropolis: after which he obtained his qualifications as a surgeon from the Royal College of Surgeons, in London; and was appointed, in 1805, a medical officer in the hospital department of the public service, being employed, during the most interesting part of the late war, at Stapleton, Haslar, and Forton. Since he commenced practice, he has confined himself to this particular class of diseases. ;

XV education should be so conducted, as to make every one first acquainted with the general principles and scope of every part of the profession; and this being once attained, and the general studies completed, then, and not till then, he should limit his pursuit to one subject ; this subject, in - consequence of his previous acquirements, he will then better understand ; he will be able to improve it by a comparison and illustration of it with the other branches he has studied, and make them all bear on this favourite or leading topic: his previous acquirements may be thus considered in the light of scattered rays, which will be all brought home to this central point or focus.

The person who is wedded to one subject acquires an intuitive knowledge from observation which cannot be conveyed

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XV1li by signs or even explained by words. It is like the amateur, who, hearing a celebrated performer play on the violin, wished to make a purchase of his instrument; on purchasing it, however, he could not give it the same tones as its master; and when complaining to the latter of his cheating him, he archly replied, “ Ah, you forgot, you should have purchased my _ fingers In estimating the different senses, how important is the sense of hearing to man ; itis the grand medium which connects him with society, and that extends information and intelligence far beyond what the eye, or any of the other senses, can do. Through this medium, he is enabled to conduct the great and complicated business of life. By it his harangue is heard in the senate, and his commands in the field. It forms the

X1X mutual and unembarrassed communication of all sentiment and expression.

The organ of voice, the most preeminent distinction of man, is even useless, unless its powers are excited through the agency of this sense; and where hearing is defective in early life, dumbness is generally _ the consequence.

A remarkable instance of the leading influence of this sense is recorded in the French Memoirs, and quoted by the Count de Buffon; where the want of hearing seemed even to prevent the very developement of the mind.

“ A young man of the town of Chartres, about twenty-four, who had been deaf from his birth, began all at once to speak, to the astonishment of all who knew him.

“ He informed his friends, that for three or four months before he had heard the

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XX sound of bells; and that he was extremely surprised at this new and unknown sensation. | «Some time after, a kind of humour issued from his left ear, and then he heard distinctly with both. During these three or four months, he listened to every thing; and without attempting to speak aloud, he accustomed himself to utter softly the words spoken by others. He laboured hard in acquiring the pronunciation of words, and in learning the ideas annexed to them. At length, thinking himself qualified to break silence, he declared he could speak, though still imperfectly. Soon after he — was interrogated by some able divines, concerning his former condition. The principal questions turned upon God, the soul, and moral good and evil; but of these subjects he seemed to have not the smallest

XX1 conception. ‘Though he was born of Catholic parents, attended mass, was instructed to make the sign of the cross, and to assume all the external marks of devotion, he comprehended nothing of their real intention. He had formed no distinct idea of death, and existed purely in an animal state: wholly occupied with sensible objects, and with the few ideas he had acquired by the eye, he drew no conclusions from them. He did not want parts; but the understanding of a man, when deprived of the intercourse of society, has so little exercise or cultivation, that he never thinks but when sensible objects obtrude themselves on his mind. ‘The great source of human ideas arises fron the reciprocal intercourse of society.” Page 283, vol. 3.

Thus the defect of hearing appears to have locked up, as it were, the mental and

XXIl rational powers; a strong proof of the necessity of the intercourse of society, to give the mind its information and proper feeling, and to rouse its different energies. The same thing is confirmed by the account given of a savage boy found in the woods of Ardennes, in France, who for want of this social intercourse, which can only take place through the influence of hearing, possessed neither the powers of language, nor any other feelings or ideas beyond those of other animals*. An account of

* So successful has the author been in his practice, that he was induced some time since, to address the following letter to the Committee of Governors of the Asylum for the Deaf and Dumb. His object was that in addition to the consulting surgeon at present appointed to that establishment, there should be an attending surgeon or aurist, who should minutely examine every child offered for presentation, prior to their being admitted into the asylum, and report his opinion to the committee how far curable or otherwise.

Since the publication of the following letter, the author

XX1 this case. was published some years ago, by Dr. Reid, of the Royal College of Physicians.

is more strongly convinced of the necessity of this examination and selection ; for, by the last report of the Deaf and Dumb Asylum, April 11, 1826, it is stated, that, out of 17 families, there are no less than 78 deaf and dumb children. From this fact, it is much to be wished that a part of the Asylum should be set aside for the medical and surgical treatment of cases in early infancy, and not confined to a symbolical education in youth,

Soho Square, Jan. 11, 1817.

GENTLEMEN,

In presuming to address you on the subject which so materially interests the Institution for the Deaf and Dumb, your patronage of which does you so much credit, I beg leave to premise, that my object is not to interfere in the least with the present medical establishment ; as I have the highest opinion of the professional talents and deserved reputation of the medical officers you have been pleased to nominate: but these gentlemen, I have no doubt, are too liberal in their sentiments, not to admit that the defect of being deaf and dumb calls for an exclusive attention to these particular organs, greater than can be paid by any practitioner in general practice, however distinguished his abilities or extensive his science, from wanting that particular expertence which one exclusively confining himself to this department of surgery must possess. |

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In estimating the value of the different senses, the best criterion to go by is the opinion of such persons who have been partially deprived of them.

_A blind man, who has been for years in that state, when desired to make a choice whether he would prefer the restoration of sight, on condition of the loss of hearing,

In consequence of this, I beg leave most respectfully to suggest to your consideration the advantage that would result to the Institution, were an aurist appointed to attend, and minutely examine the particular defect in each child admitted into your establishment ; by this means an opportunity would be given of trying such methods as appear best calculated to give relief; and by this plan I conceive many of the objects of your laudable charity might probably be found curable, restored to society, and rendered useful; by which the bounds of your humane establishment would be extended, and greater scope given to your highly benevolent views.

I have the honor to be, gentlemen, With great respect, Your most obedient humble servant, Joun Harrison Curtis.

To the Chairman, and Committee, for the deaf and dumb.

XXV has been heard to say, that he considered himself happy, though blind, while he was able to converse with his friends.

Though this is in general the case, it is amazing, in some instances of early blindness, to what perfection hearing has arrived,

with a view to supply the deficiency of the other sense.

The situation of the ear 1s more internal and its powers more concentrated than those of the eye; its nervous expansion is -more limited, and the bodies which act upon it are denser and more solid than those of light; hence the sensations conveyed by it are limited, though more durable than those of the eye.

If experience and improved knowledge have shown how much can be done to rectify the imperfections and diseases of the eye—the same experience, and the

XXVI same ardent desire of improvement, cannot fail to be equally successful in those of the ear.

But the ear, though the most important of all the senses, has hitherto claimed but little attention from the profession. The diseases of every other organ are well understood, together with the modes of repairing their defects; but the imperfections of this sense having been little attended to by the regular profession, the treatment has been, for the most part, confined to the hands of empirics. However, Iam happy to see that several respectable practitioners have of late paid some attention to this neglected branch of practice ; although it is to be observed with regret, that others have attempted it, who are not of the profession, and consequently wholly ignorant of the subject; and that these

XXV1i pretenders have had the effrontery to condemn a practice of which they could form no correct idea: such intrusions are met with in every department of science, and are attended with much injury to the interests of society.

It has been unfortunately laid down as a maxim, that the diseases of this organ are incurable. But this opinion has no just foundation; and, in fact, might have been applied with equal propriety to the other organs, on which we daily see such admirable cures performed. Indeed, there can be no doubt but experience, joined with an ardent desire to improve, will be attended with the same success in this as in every other branch of medical science. |

But to such a length has prejudice been carried on this subject, that in cases of deafness in early childhood, where much

XXVIll might have been done, and the misfortune of settled disease in a great measure averted, no attempt has even been made to ascertain the defect, or try the smallest means of relief, under the fallacious and unfortunate idea for the sufferer, that he will outgrow the disease, or that the organ will acquire an acuteness or increased powers as life advances, which it does not possess at that period.

No opinion deserves more to be condemned, or is more against the interest of society: there are indeed diseases of this nature, but they are of the constitutional class, and depend on a general fault of habit; they are not local, or affections of one part. ‘Thus scrofula or king’s evil, as puberty advances, and the system acquires greater tone and firmness from the changes which take place at that period, loses much

XX1X of its virulence and morbid action; and, _ therefore, in a certain degree, the constitution may be said, as it acquires strength, to outgrow the disease; but even here it is found that unless medicine lend its aid numerous victims would be lost before the salutary time of life or out-growing era did arrive. |

This popular prejudice may be considered as one cause that impedes the progress of medicine, for it prevents patients from applying to the practitioner on the commencement of a malady ;—the idea of nature curing diseases in general, though _ proper to be entertained to a certain length by a professional character, should be opposed as a general opinion, from conveying a want of confidence in a science, which is justly considered as the most useful.

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The diseases of the ear, like those of other parts, are often constitutional; and the general treatment of the constitution will, therefore, influence the malady of the particular part. Thus a certain well known malady, in its constitutional form and ultimate stage, attacks the ear, and deafness 1s produced by this specific cause.

The same course of medicines that remove other constitutional symptoms has an equal effect on this organ ; and if there is no other constitutional symptom but deafness, then employing internal medicines, according to the regular method observed, will remove this complaint.

If a derangement of any principal organ take place, it will produce a sympathy in other parts of the machine, and an attention to the state of this organ will relieve the symptoms arising from sympathy: hence

XXXI1 the antiphlogistic treatment succeeds even in cases of apparent weakness, by rousing and invigorating the action of the deranged organ, which is soon extended to the rest of the system.

It is curious to remark, that though the structure of the ear has occupied the attention of the most ancient anatomists and medical writers, little advantage has been derived from their researches in a practical point of view. We find in examining the early authors that Alemeon in particular, an illustrious Crotonian philosopher, studied this organ: he lived shortly after the time of Hippocrates, who flourished 400 years before the birth of Christ. Aristotle frequently quotes the anatomical ideas of Alemeon, and in Scaliger’s edition of that author’s works, the Stagyrite expressly

_ devotes his time to confute the notions of

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Alemeon. Aristotle himself treats the subject of this organ of sense more correctly, for we find him dividing the external ear into a pars innominata and lobus, which he says are wholly composed of cartilage and flesh ; the inner part he likens to a shell, from which there is no passage into the brain, but one into the cavity of the mouth, meaning, the tube which Eustachius took the credit of discovering. -But without entering into a minute detail, it may be sufficient to observe, that the following is a numerous list of ancient authors who have all treated on the. ear, though little advantage can now be derived from the perusal of what they have left us.

The remarks of Ingrassius will be found ‘an Galen, Libr. de Oss. p. 57. In Nemesius’ work, who flourished, according to

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Mercurialis, in the times of Gratian and Theodosius, about 150 years after Galen, we learn he wrote on the senses, and in cap. x. de Auditu. Also Bernardus Gordonius may be consulted, p. 291 de Aure.— Bartholomeus Anglicus de v. sensibus in totidem capitibus. Nicolaus Nicolus, Serm. _ 8, tract. primi, cap. v. de Sensu Auditus.— Johannes Matthzeus de Gradibus, de Anatoma Auris, c. 103. Johannes Anglicus, otherwise Johannes de Gadisden, de Anatomia Aurium.—Likewise Alexander Achillinus; this author first gave the names of malleus and incus to the two bones in the ear, and Jacobus Berengarius, commonly called Carpus, also notices these two bones adjacent to the tympanum, which move, he says, by the percussion of the air, and thus occasion sound. Nicolaus Massa likewise ascribes the discovery of these

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XXX1V two bones to Achillinus, Vide Epist. 5.— Folius, Cassebohm, Mery, Rivinus, Valsalva, C. Plancentini, and Buchner, also wrote on the ear, but are authors of a more modern day.

From the ancients, when we revert to modern times, we have to remark with some regret that the published works on this subject are few in number, and are very incomplete. Duverney, among the French, is the only author who has treated the subject scientifically, until our own

time, when Dr. Monro, of Edinburgh, first : published his very accurate Treatise on the Anatomy of the Ear; and was followed by the work of the late Mr. Saunders, which, besides the anatomy, elucidated the diseases of the ear, and introduced into the department of acoustic surgery considerable improvement. His work, however, is more

XXXV adapted to the profession than for general reading ; and as it is of importance that those who unfortunately labour under a defect of hearing should have some knowledge of the particular causes of the disease, the author flatters himself that the present work will be found an acquisition of no _ small value to those for whom it 1s more especially intended.

Since the first edition of this work appeared in 1817,several works have been published on the subject in France, Italy, Germany,&c. Amongst these may be mentioned | the writings of Weber, Malatides, Majendie, : Lallemand, Deleau, Alard, and Itard; like- : wise much useful information on this highly important subject has lately appeared in the | different. medical journals. As it may be i interesting to the reader, however, to know | what is doing on the Continent, I have in- |

XXXV1 terspersed in this edition such extracts from these works as appeared to be most useful.

The work is necessarily concise; but any gentleman, desirous of further investigating this interesting subject, may have an opportunity of so doing, by attending the lectures of the author, and the practice of the Royal Dispensary.

TREATISE, &e.

CHAPTER LI.

Of the Structure and Uses of the different Parts of the Ear.

A HoLLow cavern seems the general structure of the organ of hearing, as best fitted for receiving, and reflecting sound.

So necessary is this cavernous shape of the external ear to the reception of sound, that we are told the celebrated tyrant of Syracuse, Dionysius, caused a cavern to be formed in a rock, corresponding to the shape of the human ear, where he used to confine his state prisoners; and from the

B strong vibration, and echoes of the sound, he was enabled to learn the secret conversations they held, and thus condemn or acquit them accordingly. __

In the different tribes of animals, it is liable to considerable varieties in the appearance and manner of its formation, and in its appendages. | |

In man it is more perfect in its structure, than in any other animal: and it is, also, of more importance to him than to any other of the creation.

All animals, as far as we know, possess this sense; it was formerly doubted with respect to fishes. The organ of hearing in fishes was first. discovered by the late Mr. John Hunter, and is prosecuted at considerable length in his work on the organ _ of hearing in fishes, by the late Professor Monro, of Edinburgh. Thus the modern o9

-yésearches and discoveries in comparative anatomy, have sufficiently established their possession of this sense, as well as the other classes. :

The impressions the organ of hearing receives, are conveyed through the medium of air, which acquires from the action of the body communicating sound, a tremulous motion or vibration; and as these motions or vibrations succeed each other, sound is impressed or directed to the thin membrane stretched obliquely across the auditory passage, named the tympanum, where it produces a similar motion, which latter motion carried on, excites a corresponding feeling in the mind.

That sound can only be conveyed through the medium of air, is fully confirmed by the experiments of the diving-bell; for if a sonorous body is placed in it, as a bell for

B 2 example, in consequence of its being exhausted of air, no sound is produced, nor can the ringing of the bell be heard. Though hearing is more perfect in man than in any other animal, it is not so at the period of birth; an infant hears at first very imperfectly, and only strong sounds; but this arises, in part, from the passage, or meatus externus, being covered with a viscid mucus, or discharge from the ceruminous glands of the ear, in a similar manner as the meconium fills up the intestines: on the removal of this layer or deposition, the sense soon appears perfect, but not so strong as at an after period of life. Indeed, as we find the meconium, with some children at birth possesses a morbid viscidity; so in the same manner the secretion most analogous to it will partake of a similar state, and may, therefore, be suspected where congenital deafness occurs by examining the state of the first passages, or prime vie.

In all animals, the ear is divided into an external and internal part, and the difference in the structure of the organ of hearing is greater in the external ear than in the internal.

In quadrupeds this difference of structure 1s more conspicuous than in the rest, and this difference or variety seems intended to adapt the animal the better for its particular circumstances or mode of life.

On examining the external ear in quadrupeds, it is found to resemble the oblique section of a cone, from near the apex to the base. Hares, and other animals exposed to danger, and liable to be attacked by man or beasts of prey, have large ears, and they are particularly directed backwards; while their eyes at the same time, full and prominent, warn them of any danger in front. Rapacious animals, on the contrary, have their ears placed directly forwards, as is observable in the lion, the tiger, the cat, and others. Where the peculiar nature of animals is such as to require that sound be distinctly heard from a low situation, as, for instance, slow hounds and others, they will be found to have either large pendulous ears, or to have them flexible, since they move their heads with more difficulty than man.