Report on  Otology.
     By SAM'L J.  JONES, A.M., M.D.,
' Professor of Ophthalmology and Otology, Chicago Medical College.
Read Before the Illinois State Medical Society.
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REPORT   ON  OTOLOGY.
  Your Committee having, in the last Annual Report, given a
general  view of Otology, confine the present  one  chiefly to
matters  of material interest  pertaining to the  progress made,
more especially during  the last year, regarding diagnosis and
the treatment of some of the  more frequent diseases of the ear.
  One of the most evident assurances of advancement, in diag-
nosis, is the gradual diminution in the number of cases formerly
classified as nervous deafness.  The cases in  which we must
regard  the primary lesion as  of nervous origin are but few.
  The  usefulness of the  ordinary tuning-fork  of musicians is
becoming more extended  as  an aid  in diagnosis.  Next to in-
flating  the Eustachian tubes,  it is, perhaps, the most convenient
mode of determining whether or not the Eustachian tubes be
closed.  If such closure exists, pressing the tragus  back, so as
to close the meatus, will render the sound produced by placing
a vibrating tuning-fork on the patient's forehead less distinct,
whilst, if the  tube be  open,  such pressure on the  tragus will
increase  considerably the sound  heard.   If, by inflating  the
tube, air enters freely, and  yet  pressure as described (on the
tragus) do not  make the sound  louder, the prognosis is less
favorable than where it increases  it.
   In the last report, special consideration was given to "chronic
catarrh of  the middle ear," in the belief that  its frequency in
this  region of country  entitled to such prominence.   Another
year's experience in the treatment of that class of cases, seems 
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to add  confirmation to the view  then expressed,  and in the
treatment of them progress is still being made.  For much of
this  we are indebted to Hinton, of London, who, with a view
to rid the  middle ear of altered  secretions there accumulated,
incises the membrana tympani and washes that cavity through
the external meatus, passing a stream down through the Eusta-
chian tube and out  through the nares,  by inclining  the head of
the patient forward, and having him keep his mouth open (as
in using the nasal  douche) when  the  soft palate is closed up
against the pharynx.
   The method of ridding  the middle  ear of its accumulation,
by incising the membrana tympani, and thus syringing  it, was
practiced several years  ago, but the stream was allowed to pass
into  the throat, making  the process so  disagreeable  to .the
patient  as  to have aided in bringing the operation  into disuse.
Hinton  seems to have  succeeded, in  a very  simple way, in
removing one of its most disagreeable features.  His process is
the  reverse of  that  of Gruber,   of  Vienna, who  passes the
stream  in  through  the nostril and  out  through the external
meatus.  Marked improvement follows the operation in many
of these cases.

   The apparatuses designed for  making  applications of fluids
or medicated air to  the affected surface of the middle ear, have
been considerably  simplified,  and the means of ascertaining
definitely of their passing  into that cavity better established.
   The importance of having the  Eustachian tube in such con-
dition that air can enter it with each respiratory movement, is
impressing  itself more fully, and renders advisable the frequent
using of the Valsulvian method of inflating in all cases of thick-
ening of the mucous membrane of the tube.
   Trbltsch dwells with considerable emphasis on a class of cases
which he  calls,  "Purulent Aural  Catarrh in Children," and
which seems to have escaped general  attention.   Most  that is
known regarding them has  been obtained by post mortem ex-
amination by  Trb'ltch, Wrcden, and  a few others.   The large 
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proportion of  cases in which pus has been found in tfye cavity
of the tympanum, and in the mastoid cells, when not suspected
during life, seems to merit more consideration of them than has
heretofore been given them, and may  explain  many of those
head  symptoms children  are so frequently  affected  with,  and
which are often attributed to vague supposable causes.   As kin-
dred  to these  Trbltsch speaks of another class, which he desig-
nates "Infantile Otitis," but which, in many respects, especially
in its earlier stages, is identical with the aural catarrh before
referred to, and  only when the inflammation has become more
diffuse deserves a different designation.

   These cases naturally lead us to consideration of the conclu-
sions  he has drawn,  that, in many instances, those mysterious
cases which happen  to  all physicians  who treat disease of
children, and  in  which a satisfactory diagnosis is not arrived
at before death, but where the convenient cause of "teething"
is made to account for a train of symptoms that precede death,
are ascriljable to  disease originating in  the ear and secondarily
affecting the brain.   In determining this point exclusion serves
us well.   Evidence of great pain is manifested  in the continu-
ous crying of  the child, who, often is unable to speak, and  can
give no idea of its location.  That it is not located  in the ali-
mentary canal, is determined  by the absence of the physical
signs of inflammation there; that it is not yet seated in the
brain, may be  likewise determined, and thus, when once atten-
tion is drawn  to the probable locality of the lesion, and it is
remembered how large a proportion of  children evince this con-
dition after death, careful examination will  render diagnosis of
such cases easier.
   In  the  treatment of discharge of pus from the ear, whether
from  the external  meatus or from the middle ear  through  a
perforated membrana tympani, syringing  the  ear thoroughly
with a solution of sulphate of zinc, with the addition of  some
carbolic acid,  gives, perhaps, more satisfactory results than any
other remedial measure.   Especially is the carbolic acid service-
able in cases where the parasite asperquillus glaucus  is present. 
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Regarding this,  Schwartze says, "it  appears probable  that
this vegetable parasite is more frequently a cause of the obsti-
nate, frequently relapsing,  and chronic  inflammation of the ex-
ternal  auditory canal  than is generally supposed." Investiga-
tion of this subject, by Green, of Boston, and others, has led to
similar conclusions.
  The use of electricity in the treatment of aural disease, is
both commended  and  condemned by  aural  surgeons.   The
truth  in  this case, as in many others, probably lies in a mean
between  either extreme view.   The chief objection to its  use
lying  in  the fact that we have not yet  learned  to discriminate
sufficiently accurately as to the conditions of  its applicability,
and, instead  of condemning it, further  investigation as to  the
laws of its action on the human system is desirable.   Some curi-
ous phenomena evinced themselves in experimenting upon the
effects of electricity upon the auditory apparatus and have led
to the inquiry whether or not  their exists "accommodation" in
the ear, as we have it in the eye, whether some muscular action
in the ear is not exerted in a similar manner to be investigated,
  Reasoning from  the  effects  of  strychnia upon the  nervous
system generally, it naturally would  be  suspected that it might
be eniployed  with advantage in  those cases where the function
of the auditory nerves is believed to be impaired, but experience
seems to show that the ordinary effects of this drug are not ex-
erted on nerves of special sensation.  Hence the disappointment
that has resulted in the cases where employed to restore  the
action  of the auditory nerve,  as well as in impairment of the
function  of the optic nerve.
  The introduction of chloracetic acid  as  a caustic, has given
us another convenient  means of removing  aural  polypi; being
readily soluble in water, it may, after having remained suffici-
ently  long in contact with the polypus, be readily washed  out
of the  meatus by syringing, without serious effect to  the  sur*
rounding tissue.
  Your  Committee would  gladly dwell more at length on dis- 
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eases of the ear did the time of the Society admit.   Their great
frequency and importance  merit such consideration.

  When such authority as Trbltsch is led, by his experience, to
the belief that there are more ear cases than eye cases, and to
assert, as his conviction, that not more than one in every three
persons,  between the ages of twenty and  forty years,  possess
strictly normal hearing  in both ears, we must feel convinced,
that if the number be but one-half as great as represented by
him, their frequency entitles them to more study  than is ac-
corded them by the general profession. As to their importance,    *
we readily recognize the great disadvantage that persons labor
under  whose faculty of  hearing has  become greatly impaired,
and to what extent they are disqualified  for many of the voca-
tions of life.  The earnestness  with which  these sufferers plead
for relief shows how deeply they feel  their loss.
  It may not be amiss to conclude this report with some  gen-
eral suggestions as to the proper mode of conducting examina-
tions of the ear.

   Of first  importance,  is careful  inspection  of the membrana
tympani.  The simple means of illumination now at our  com-
mand gives us all  needed facility for that purpose.  We  must
familiarize ourselves  with  the normal appearance of the mem-
brane, during life,  by  frequent inspection of it in  health, that
we may  detect variations from that standard in disease; then,
having  recognized  these changes,  we must learn to  interpret
their  meaning.   As well might an effort be made to study the
appearance of a healthy cornea on the dead  subject, as to try
to get a correct idea of the appearance  of the healthy mem-
brane of the drum by inspecting  it after the changes in it
which occur after  death.  We must regard  the membrane of
the drum as giving us the key to diagnosis of disease of the
ear,  and further investigation as but supplementing  such  in-
spection of it.  An elastic tube placed with one end in the ear
of the surgeon, the other being in the ear of the patient, will
act as the stethoscope  does  in examination  of the chest, and 
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convey to the ear of the surgeon  the  sound produced  by air
passing through the Eustachian tube into the  middle ear, that
sound  being  influenced by the condition  of the parts through
which  the air passes, and a  practised ear of the surgeon will
enable him  to interpret  the characteristic  of the sound,  as
readily as may be done in auscultation of the chest.