A practical treatise on the diseases of the ear, including a sketch of aural anatomy and physiology

Front matter

^ V b ■' o

W

, X

Preface To The Sixth Edition

It is now eleven years since the first edition of this work was published. The manner in which it has been received by the profession of this country and of Great Britain and Ireland, has been a source of great gratification to me. I offer my hearty thanks to my brethren for having given my labors in otology such a kind appreciation. In revising this book, while perhaps no page has escaped alteration, and many pages have been added, pains have been taken to preserve the original plan. It was written for three classes of readers. First, it is intended to be a means by which advanced medical students may acquire a knowledge of the diseases and anatomy of the ear. Second, it is designed for general practitioners, to whom it may be a guide for the diagnosis and treatment of cases actually in hand. Third, I also hope, that professional men who interest themselves largely or exclusively in otology, may in the future as in the past, find in it something of interest and profit to them.

The larger part of the work is essentially a digest of my own experience in the treatment of diseases of the ear, now extending over more than twelve thousand cases for which I have had the personal responsibility. The nomenclature of this book has been accepted quite generally in the profession, and some of the views which were set forth for the first time in the first edition, have been recognized as true, and have taken their place in the great structure of human knowledge.

In this edition, it will be found that I have endeavored to

Vlll PREFACE TO THE SIXTH EDITION.

make deductions from my clinical experience in certain novel directions. Time will eventually establish the truth, or expose the incorrectness of the conclusions which I have drawn from my cases. If any of them are wrong, the facts at least will remain, I trust, a substantial contribution to a department of medicine to which I have given some of the best years of my life.

I wish to express my thanks to my valued friend, Dr. Charles E. Hackley, for his aid and advice in correcting the proofs, also to Dr. J. B. Emerson for the preparation of the index, and much other assistance.

Man}^ of the anatomical illustrations were prepared expressly for this edition, and most of these are from the museum of my distinguished colleague, Professor William Darling. While engaged upon this work, Dr. John L. Yandervoort has extended to me great courtesy in his official position as Librarian of the Xew York Hospital. Many of the engravings of instruments were furnished me by Messrs. John Reynders & Co.

New York, November 1, 1884.

Preface To The First Edition

This work is intended to be a guide to those who wish to treat the diseases of the ear. The portion that is devoted to a description of these diseases, and the means for their relief and cure, is founded upon my own experience in the observation and treatment of more than thirty-eight hundred cases, in public and private practice. I have, however, taken pains to give the experience of other practitioners, both at home and abroad. I have endeavored not only to give a comprehensive digest of the most recent European researches, but also to present, with entire impartiality, the views and experiences of American practitioners and writers, so far as the plan of a practical treatise like this would allow. To give a complete account of all that has been written on otology has not, however, been my aim.

Considerable space has been given to illustrative cases, with a view of showing the actual symptoms of aural diseases and the results of treatment. I have also added historical sketches upon all points of practice that are new or still under discussion, in order that the successive steps by which our present position has been reached might be distinctly traced, believing that thereby the practitioner will often be saved needless labor in re-investigating and re-experimenting. The nomenclature contained in this treatise is that which I have found, after some j^ears of experience in lecturing upon diseases of the ear, most readily grasped by the student, and is, I believe, founded upon the real nature of the diseases.

The anatomical portion of the volume has been compiled from the most recent authorities. The text-book of Professor ,1. Henle, of Gottingen, a work which has not been translated into

X PREFACE TO THE FIRST EDITION.

English, has been made the general basis of the descriptions of the various parts of the ear, and of the arrangement of the subject.

In the preface to a translation of "Yon Troltsch on the Ear," published a little more than nine years since, the translator had so little faith in a general professional interest in the diagnosis and treatment of diseases of the ear, that he quoted a proverb to indicate that an ordinary human life would not suffice to see the fruit of the tree then being planted, in presenting to the English-speaking profession a work which has done much for the progress of otology. 1 „

In view, however, of the active and permanent interest in this subject, which has shown itself in the formation of societies, the establishment of journals, improvements in methods of practice, and a general appreciation of diseases of the ear, the author can but felicitate himself that even in a short life .he has seen some fruit of a tree, which, although he did not plant, he at least assisted in cultivating.

The practice of otology in this country was, a few years since, almost exclusively confined to charlatans ; but it is now cultivated by a class of men who are the equals of any in the profession. Ten years ago, in most parts of the country, those who wished advice upon a disease of the ear were forced to seek aid outside of the profession. At the present time, there can be found those in the large cities who are constantly and successfully treating aural diseases ; and all over the land the old and familiar advice, " Not to meddle with the ear," is growing far less frequent. The day will soon arrive — if indeed it be not already upon us — when otology will take equal rank with ophthalmology, to which department it has so long been a mere appendage, and when some knowledge of the diseases and treatment of the ear will be required of every practitioner.

I have been assisted in various ways, in the preparation of this work, by many who may rest assured that I have not been unmindful of their labors because their names are not here mentioned ; but to Dr. Charles E. Rider, of Rochester, for assistance in compiling the anatomy of the middle ear, and to Dr. George M. Beard, for critical suggestions in the literary execution of the work, of a very valuable character, I am much in-

Preface To The First Edition. XI

debted, and to both of these gentlemen I desire to present my cordial acknowledgments.

It is believed that in the foot-notes, the various authorities whom I have consulted Lave been given proper credit, and they are given in full at the close of the sketch of the progress of otology, and at the end of each anatomical section, in order that an aural bibliography of works actually consulted by the author, and accessible in this country, may be furnished to any who ma}^ desire to pursue any special subjects further than would be fitting the limits of a text-book.

Most of the engravings were made by Messrs. J. A. Cough- Ian & Co. Those of instruments were furnished by Messrs. Shepard & Dudley, Otto & Reynders, and George Tiemann & Co., of this city.

The chromo-lithographs were drawn by Dr. H. P. Quincy, of Boston, from cases loaned me by Drs. Clarence J. Blake and Henry L. Shaw, Surgeons to the Massachusetts Charitable Eye and Ear Infirmary. Without the assistance of these gentlemen, I should have found it very difficult to procure satisfactory representations of the morbid membrana tympani. Dr. John L. Yandervoort, Librarian of the New York Hospital, has extended me many courtesies in giving me free access to the valuable library of that institution.

New Yoek, May 29, 1873.

Chapter I. A Sketch Of The Peogeess Of Otology With A Bibli

OGEAPHY.

PAGE

Vastness of Otological Literature. — Apathy in regard to Diseases of the Ear. — Wilde the Reformer of the Science. — Carl Gustav Lincke and his Handbook. — Papyrus Ebers. — Hippocrates and his Knowledge of the Ear. — Alcmseou the Discoverer of the Eustachian Tube. — Rufus of Ephesus. — Aristotle. — Discoveries in the Time of the Ptolemys. — Galen and the Want of Progress in his Time. — Achillini and Berengario describe the Ossicles. — Vesalius the most accurate Anatomist of his Day. — Ingrassia, Columbo, and Eustachius each claims Discovery of Stapes. — Fallopius and his Career. — Anatomical Writings of Eustachius. — First Monograph on Anatomy of the Ear. — Constant Varolius. — Fabricius of Aquapendente. — Valsalva. — Casserius, a Pupil and Rival of Fabricius. — Stenon describes Ceruminous Glands. — Discovery of Helicotrema. — Du Verney and his Plates. — Cotugno and the Aqueducts. — Meckel. — Rivinian Foramen. — Hyrtl and Bochdalek upon its Existence. — Ruysch. — Brendel and Zinn. — Scarpa upon the Internal Ear. — Saunders, Todd, and others. — Monro's Claim to have first traced the Nerves into the Cochlea, Vestibule, and Semicircular Canals. — Everard Home's Account of the Membrana Tympani. — Soemmering. — Shrapnell. — Thomas Buchanan on the Importance of Cerumen. — Wharton Jones. — Discoveries of Toynbee. — Troltsch, Politzer, Lucre, and others. — The Organ of Corti and its Discoverer. — Pathological Anatomy of the Ear. — Progress in Treatment of Aural Disease. — Herodotus on Specialists. — The Remedies suggested by Hippocrates. — Celsus. — Archigenes on Venesection and Foreign Bodies. — Galen on Noise. — Peculiar Method of removing Foreign Body from Ear. — Paulus iEgineta, his Classification and Operation. — Arabians, their Knowledge of Otology. — Paracelsus burning Books of his Predecessors. — Capivacci on Differential Diagnosis. — Ambroise Pare first uses a Syringe for the Ear.— The Education of Deaf Mutes.— Old Method of detecting Inspissated Cerumen. — Lusitanus on cutting off Ears of Thieves. — Fabricius of Hilden. — Thomas Willis, his Observations on Hearing in a Noise. — The Therapeutical Work of Valsalva. — Petit on Caries of the Mastoid. — The Discovery of the Eustachian Catheter. — Guyot, Cleland. — Perforation of the Membrana Tympani. — Trephining the Mastoid. — Sir Astley Cooper. — Saunders on Perforation of the Membrana Tympani. — First Infirmary tor Diseases of the Ear. — Saissy, Itard, Beck. — Sketch of Kramer's Career. — Discovery of Artificial Membrana Tympani.— Yearsley. — Wilde and his great Work in Otology. — The Text-books of Toynbee, Troltsch, Erbard. — Modern Text-books and Journals. — Bibliography, 1

XIV CONTENTS.

Chapter II. The Examination Of Aukal Patients

PAGE

History. — Power of Hearing Conversation. — Test Sentences. — Tick of a Watch. — Tuning-fork. — -Aerial and Bone Conduction. — Malingering. — Angular Forceps. — Specula. — Troltsch's Otoscope. — Examination of Pharynx. — Rhinoscopy. — Use of Eustachian Catheter. — Politzer's Method and its so-called Modifications. — Bougies. — Valsalva's Method, 44

Chapter III

anatomy; and physiology of the auricle and the external auditory canal.

Auricle. — Etymology. — Anatomy of Muscles, Intrinsic and External. — Physiology. — Blood-vessels. — Nerves. — External Auditory Canal. — Anatomy of Curvature. — Ceruminous Glands. — Hairs in Canal. — Auditory Canal of Dog and Cat. — Relations of Canal to Parotid Gland, Inferior Maxilla, Mastoid Process, and Dura Mater. — Blood-vessels and Nerves, .81

Chapter IV. The Malformations And Diseases Of The Auricle

A Finely Formed Auricle an Indication of Character. — Malformations. — Superfluous Auricles. — Ely's operation for Prominent Auricles. — Tumors. — Angiomata. — Othsematomata. — Perichondritis. — Malignant Growths. — Syphilitic Affections. — Erysipelas. — Effects of Gout, 97

Chapter V

DIFFUSE AND CIRCUMSCRIBED INFLAMMATION OF THE EXTER- NAL AUDITORY CANAL.

Comparative Frequency of these Affections. — Diffuse Inflammation. — Leeches. — Incisions. — Warm Douche. — Fountain Syringe. — Fayette Taylor's Douche. — Method of Syringing. — Syringes. — Anodynes. — Desquamative Inflammation. — Furuncles. — Local and Constitutional Treatment. — Calcium Sulphide. — Lowenburg's Views, ........... 122

Chapter VI

PARASITIC INFLAMMATION OF THE EXTERNAL AUDITORY CANAL —SYPHILITIC ULCERS AND CONDYLOMATA— CONTRACTIONS- DIPHTHERIA— SARCOMA— CARIES.

History of the Discovery of the Growth of Aspergillus in the External Auditory Canal. — Varieties of Vegetable Fungi found in the Ear. — Cases. — Syphilitic Ulcers and Condylomata. — Narrowing and Closure of the Canal. — Diphtheritic Inflammation. — Sarcoma. — Caries of the Canal, ...... 141

CONTENTS. XV

Chapter VII. Inspissated Cerumen

PAGE

Merely a Symptom of Aural Inflammation. — Frequency of the Affection. — Symptoms. — Reported Cases of Damage to the Ear from the Presence of Wax, probably not based on Correct Observation. — Causes. — Treatment. — Cases, . . 156

Chapter VIII. Foreign Bodies

Exaggeration of the Importance of this Subject. — Statistics. — Insects. — Living Larvae. — Fish. — Inanimate Foreign Bodies. — Treatment. — Delusions as to Foreign Bodies in the Ear. — Foreign Bodies in the Eustachian Tube. — Ear Cough, . 177

Chapter IX. Anatomy And Physiology Of The Middle Ear

Statistics of Diseases of the Middle Ear. — Membrana Tympani. — Shrapnell's Membrane. — Rivinian Foramen. — Light Spot. — Layers. — Blood-vessels. — Nerves. — Lymphatics. — Cavity of the Tympanum. — Scheme for Studying Boundaries of this Cavity. — Ossicula Auditus. — Blood-vessels. — Nerves. — Mastoid Process. — Eustachian Tube, Historical Account of. — Physiology of the Middle Ear, 211

Chapter X

Injuries of the Membrana Tympani. — Diseases of the Membrana Tympani not Independent Affections. — Vascular, Nervous, and Lymphatic Supply, a Part of that of the Canal and Middle Ear. — Drum-head Subject to Injury by Explosions, Blows, and so forth. — Effects of Condensed Air. — Serious Injuries of the Head. — Fracture of the Handle of the Malleus, ...... 257

CHAPTER XL

ACUTE CATARRHAL INFLAMMATION OF THE MIDDLE EAR.

Nomenclature. — Statistics. — Symptoms. — Treatment. — Leeches. — Paracentesis. — Subacute Catarrh. — Hemorrhagic Inflammation of the Middle Ear. — Aural Hemorrhage in Bright's Disease. — Vascular Tumors of the Drum-head, . . 276

Chapter XII. Acute Suppuration Of The Middle Ear

A Consequence of Acute Catarrh. — Symptoms. — Causes. — Course. — Cases of Meningitis Consecutive to Acute Catarrh and Suppuration. — Criticisms upon the Modern Antiphlogistic Treatment. — Neurotic Cases. — Treatment and Cases. — Acute Serous Inflammation of the Middle Ear, 305

XVI CONTENTS.

Chapter XIII

CHRONIC NON-SUPPURATIVE INFLAMMATION OF THE MID- DLE . EAR.

PAGE

Frequency of this Disease. — Nomenclature. — Catarrh. — Proliferous Inflammation. — Subjective Symptoms. — Vertigo. — Tinnitus Aurium. — Insanity. — Subjective Symptoms of Proliferous Inflammation. — Objective Symptoms. — Impairment of Hearing. — Changes in the Membrana Tympani. — -Eustachian Tube.— Naso-pharyngeal Inflammation. — Adenoid Growths. —Pathology. — Causes, . 337

CHAPTER XIY.

CHRONIC NON-SUPPURATIVE INFLAMMATION OF THE MIDDLE

EAR — ( Continued) .

Treatment of the Catarrhal and Proliferous Forms. — Constitutional and Hygienic Applications to the Naso-pharyngeal Space. — Nasal Douche. — Cases of Acute Aural Disease caused by its Use. — Gruber's Method of Cleansing Nares. — Politzer's Method. — Anatomy of Nasal Cavities. — Nebulizers. — Faucial Catheters. — Removal of the Tonsils. — Treatment through the Eustachian Tube. — Air. Steam. — Vapors. — Fluids. — Bougies — Electricity. — Death from Improper Use of Catheter. — Duration of Treatment. — Prognosis, ..... 378

Chapter XV

THE TREATMENT OF CHRONIC NON-SUPPURATIVE INFLAM- MATION— ( Concluded).

Operations upon and through the Membrana Tympani. — History from 1650 until our own Day. — Sir Astley Cooper's Cases. — Schwartze's Statistics. — Politzer's Eyelet. — Tenotomy of Tensor-tympani. — Galvano-cautery. — Division of Posterior Fold. — Prout's Operation. — Hinton's Removal of Accumulations of Mucus. — Abandonment of Operations by American Otologists. — Condensed Air. — Exhaustion of Air. — Weber-Liel and Woakes on Paretic Deafness. — Results of Treatment, 412

Chapter XVI. Chronic Suppuration Of The Middle Ear

Consequence of Acute Suppuration. — Otorrhcea an Improper Term. — Often confounded with Chronic Inflammation of the Canal. — Relative Frequency of the two Affections. — Symptoms. —Perforations of Membrana Tympani.— Treatment. — Syringing. — Astringents.— Fluids. — Powders. — Electricity. — Artificial Membrana Tympani. — Cases. — Prognosis, .....-• 431)

Chapter XVII. The Consequences Of Chronic Suppuration Of The Middle Ear

Chronic Suppuration and its Results Inevitably Dangerous to the Health and Life of the Patient. — Refusal of Life Insurance Companies to take Risks of such Cases. — Cicatrices and Adhesions in the Tympanum. — Polypi. — Exostoses. — Mathewson's Operation for their Removal. — Cases, 468

CONTENTS. XVI 1

Chapter XVIII

THE CONSEQUENCES OE CHKONIC SUPPUEATION OF THE MIDDLE EAR— ( Continued) .

PAGE

Diseases of the Mastoid Process. — Periostitis. — Caries and Suppuration. — Trei/hining or Opening the Mastoid. — Historical Account of the Operation.— Cases, . 401

Chapter XIX

THE CONSEQUENCES OF CHRONIC SUPPURATION OF THE MIDDLE EAR— {Concluded).— NEURALGIA OF THE MIDDLE EAR.

Caries and Necrosis of the Temporal Bone. — Cases. — Treatment by Operation and Internal Medication. — Fatal Hemorrhage. — Cerebral Abscess. — Pyaemia. — Paralysis. — The Ophthalmoscope in detecting Cerebral Disease of Aural Origin. — Neuralgia of the Middle Ear, 527

Chapter XX. Anatomy And Physiology Of The Internal Ear

The Vestibule, Semi-circular Canals, Cochlea, and Auditory Nerve. — Physiology

of the Internal Ear, ........... 569

Chapter XXI. Diseases Of The Internal Ear

Difficulty in Diagnosis. — Clinical and Pathological Advances. — Differentiation between Diseases of Middle and Internal Ear. — Nervousness and Nervous Deafness. — Symptoms of Primary Disease of the Cochlea. — Acoustic Neuritis. — Atrophy of the Acoustic Nerve. — Cases. — The Tuning-fork in Diagnosis. — Deafness to Certain Tones. — Double Hearing. — Electricity. — Syphilitic Disease of the Cochlea. — Cochlitis. — Cases, . 590

CHAPTER XXII. DISEASES OF THE INTERNAL EAR— {Concluded)

The Effects of Quinine. — Cerebro-spinal Meningitis. — Meningitis. — Disease of the Spinal Cord. — Parotitis. — Acute Inflammation of Membranous Labyrinth mistaken for Cerebro-spinal Meningitis. — Hemorrhages and Effusions. — Injuries. — Concussions. — Aneurism and Tumors. — Disease of Semi-circular Canals. — Pathology. — Treatment, 619

Chapter XXIII. Deaf-muteism— Mechanical Assistance To The Hearing

Acquired and Congenital Cases. — At what Age are Children Conscious of Sounds ? — Causes. — Tables of Examination of 147 Cases. — Hearing-trumpets. — Audiphone, 663

DESCRIPTION OF THE CHROMO-LITHOGRAPHS, .... 700

INDEX OF AUTHORS, 70;*

GENERAL INDEX, 709

LIST OF WOOD-CUTS.

FIG. PAGE

2. Blake's Tuning-fork, . 57

3. Angular Forceps, 59

4. Grubers Speculum, 60

5. Method of holding the Speculum in Position, 61

6. Method of Examining the Auditory Canal and Membrana Tyinpani, . . 62

7. Collin's Lamp, . . 63

8. Forehead Band, 63

9. Blake's Operating Otoscope, 65

10. Hinge Speculum, . 66

11. Turck's Speculum, 66

12. Anterior Nares Speculum, 68

13. Goodwillie's Nasal Speculum, . . 68

14. Eustachian Catheters, actual size, ......... 70

15. Introduction of Eustachian Catheter, . . . . . . .71

16. The Eustachian Catheter in Position, 72

18. Diagnostic Tube, . 73

19. Method of Using Politzer's Apparatus (with box for containing iodine or other

evaporating substance), ........... 75

20. Dr. Allen's Nose-pads for Politzer's Apparatus, 76

21. The Auricle, • 81

22. Profile View of the Skull with the Skeleton or Cartilage of the Auricle, as

well as that of the External Auditory Canal, 82

23. Muscles of the External Ear, • . . .85

24. View of the Cartilage and Muscles on the Posterior Surface of the Auricle, 86

25. The Muscles of the Head, 90

26. Section through the External Meatus and the Ear at the Point of Junction of

the Cartilage of the Auricle with that of the Auditory Canal, . . .91

27. Horizontal Section of the Head through the External Auditory Canal, . . 92

28. Annulus Tympanicus, 92

29. Cast of Auditory Canal and Adjacent Parts, 93

30. Section of Left Temporal Bone, 93

31. External Surface Left Temporal Bone, 95

32. Case of Prominence of Auricles (front view), ....... 98

33. Case of Prominence of Auricles (posterior view), ...... 99

34. 35. Deformity of Auricles, 101

36. Othaematoma. From a photograph taken from a plaster cast when the tume-

faction was greatest, . 108

37. The same Ear after Rupture and Contraction had taken place, . . . 108

XX LIST OF WOOD-CUTS.

FIG. PAGE

38. Showing Amount of Contraction after Rupture of Cyst, 109

39. Shows Separation of Perichondrium from Cartilage, 109

40. Auricle Deformed by Inflammation, . 113

41. Tumor of the Anterior Part of Auricle and Auditory Canal, .... 117

42. Improved Fountain Syringe, 127

43. Fayette Douche, 128

44. Syringe for the Ear, 132

45. Reservoir Syringe, 132

46. Method pf Syringing the Ear, 133

47. Aspergillus Nigricans, 145

48. Aspergillus Flavescens, 146

• 49. Specimen of the Spores and fully developed Growth of the Aspergillus Flavescens, 147

50. Penicillium, 148

51. Otomyces Purpureus, 148

52. The Right Temporal Bone, without the Petrous Portion in connection with

Ossicula Auditus of a Newly-born Child, seen from within, . . . 212

53. Left Temporal Bone of the same Subject as preceding figure, ... . 212

54. Section through Tympanic Cavity, Left Side, 213

55. 56. View of Membrana Tympani, showing Handle of Malleus and Trian-

gular spot of Light, 217

57. Vertical Section of Fibrous Layer of the Membrana Tympani, . . . 319

58. The Membrana Tympani, in connection with the Ossicula Auditus of the

Right Temporal Bone, . 223

59. Temporal Bone of Left Side (inner view), ; 224

60. The Right Temporal Bone, with the Membrana Tympani and Ossicula Au-

ditus of an Adult, . 227

61. Section of Right Temporal Bone, 228

62. Section through Tympanic Cavity, Left Temporal Bone, . . . . 229

63. Tympanic Cavity with Ossicles in situ, . . . . . . . . 230

64. Anterior Surface of Malleus and Incus Articulated, 230

65. Ossicles of the Tympanum, 231

66. Posterior Surface of the Malleus, Incus, and Stapes Articulated, . . . 231

67. Vertical Section through the Right Temporal Bone, 237

68. External Surface of Left Mastoid Bone, .238

69. Vertical Section through Right Temporal Bone, 239

70. Vertical Section of Left Temporal Bone, 240

71. Section of the Head, showing the Divisions of the Ear and Naso-pharyngeal

Cavity, 242

72. Transverse Section of Upper Part of the Eustachian Tube, .... 243

73. Transverse Section through Lower End of the Eustachian Tube, . . . 244

74. Same as last, . . ' 244

75. Vertical Section, showing the Mouth of Eustachian Tube and Rosenmiiller's

Fossa, 245

76. Transverse Section of Eustachian Tube and Surrounding Parts, . . . 246

77. Section of the Upper Third of the Eustachian Tube, . . . v . .247

78. Section of the Middle Third of the Eustachian Tube, 248

79. Fracture of Handle of Malleus, displaced, . . . . . . . 275

80. Fracture of Handle of Malleus, reduced, ....... 275

81. Paracentesis Needle, . . . . 287

82. Diseases of Bone in Case of Meningitis following Acute Suppuration of Mid-

dle Ear, 313

LIST OF WOOD-CUTS. XXI

FIG. PAGE

83. Seigle's " Otoscope " with. Ely's Attachment of a Syringe, .... 366

84. Pharyngitis Granulosa, 368

85. Posterior Nares Syringe, ....... ... 381

86. Davidson's Syringe with a Nozzle to go below the Soft Palate, . . . 382

87. Vertical Section of Bones of Face (posterior half), 386

88. Vertical Section of Bones of Face (anterior half), 388

89. Nebulizer for Nostrils and Pharynx, 390

90. Tonsil Knife, 393

91. Tonsil Forceps, 393

92. Apparatus for Steaming the Middle Ear, 396

93. Bottle for the Generation of Vapor of Iodine. An ordinary air-bag is used

for forcing the vapor into the catheter, 397

94. Hackley's Eustachian Nebulizer, 401

96. Vessel Used in Syringing the Ear, ......... 450

97. Buck's Pipette, . 451

99. Toynbee's Artificial Membrana Tympani, f 461

100. Method of Inserting Artificial Membrana Tympani (Toynbee), . . . 462

101. Section of Aural Polypus, . . . 471

102. Section of Aural Polypus, 472

103. Section of Aural Polypus, 473

104. Blake's Modification of Wilde's Snare with Paracentesis Needle, . . . 476

105. Scissors for the Removal of Aural Polypi, ....... 476

106. Buck's Curettes for Clearing Auditory Canal and Tympanum, . . . 477

107. Schwartze's Chisels for Opening the Mastoid, 502

108. Left Temporal Bone, Exterior View (Necrosis), 531

109. Left Temporal Bone, Inner Surface, ........ 531

110. Left Temporal Bone, Sawed through External Meatus, Middle Ear, and

Cochlea 532

111. Bight Temporal Bone, from Case V., showing the Cranial Surface of the

Bone, 533

112. Caries of Squamous and Mastoid Portion of Temporal Bone, .... 534

113. Caries of Petrous Portion of Right Temporal Bone, 535

114. Caries of Lateral Sinus of Right Temporal Bone, 536

115. Caries of Squamous Portion of Temporal Bone, ... . . . . 536

116. A Diagram designed to show the Relations of the Tympanic Cavity to the Mas-

toid Cells, the Jugular Fossa and the Cavity of the Cranium, . . . 538

117. The Left Vestibule, with the Semi-circular Canals, from an Adult, seen from

within, 570

118. The Vestibule, 570

119. Section of Temporal Bone of Right Side through the Cochlea, . . . 572

120. Osseous Cochlea and Semi-circular Canals with Stapes Bone, Left Ear of

Adult, . 572

121. Right Osseous Vestibule, Semi-circular Canals, Cochlea, and Ossicula Auditus

122. The Right Osseous Labyrinth of a Newly Born Subject, opened on its Poste-

rior Surface, . . ' 573

123. Section of Right Temporal Bone, showing the Osseous Semi-circular Canals, . 573

124. Osseous Cochlea (Right) of the Newly Born, opened from the Outer Surface, . 574

125. Section through Cochlea and Vestibule, 575

126. Periosteum of Labyrinth, 570

XX11

LIST OF WOOD-CUTS.

127. Periosteum of trie Outer Wall of the Cochlea, ....

128. Utricle and Membranous Semi-circular Canals of the Left Side,

129. A Piece of the Wall of the Utricle, with the Otoliths,

130. Transverse Section of a Cochlea Spiral, .

131. From the Terminal Auditory Apparatus of a Cat, .

132. Profile View of Outer and Inner Rods, .

133. Membrana Basilaris, with the Terminal Nerve-Fibres,

134. Expansion of the Right Cochlea Nerve, seen from the Base of the Cochlea,

135. A Diagram designed to Illustrate the Physiology of the Labyrinth,

137. Auricles,

138. The Audiphone in its Natural Position, used as a Fan, ....

139. The Audiphone in Tension, the Proper Position for Hearing,

140. Method of using the Audiphone,

PAGE

, 582

, 582

, 583

. 697

. 697

. 698

. 698

A TEEATISE ON

THE DISEASES OF THE EAR