CONTRIBUTION TO THE PATHOLOGY 
OF THE 
TEMPORAL BONE, 
By THOMAS R. POOLEY, M. D, of New York. 
[Re-printed from the Transactions of the American otological Society. July, 
* 1879.] 
NEW BEDFORD: 
PRINTED BY THE MERCURY PUBLISHING COMPANY. 
1879. CONTRIBUTION TO THE PATHOLOGY OF THE 
TEMPORAL BONE. 
Thomas R. Pooley, M. D., of New York. 
Case I. Fracture of the Petrous portion of the Temporal 
Bone. 
The history of the case from which the specimen to be 
described was obtained is furnished, as follows, by my 
brother, Dr. J. H. Pooley, of Columbus, Ohio: "On the 
evening of Oct. 29, 1878, I was called in consultation to see 
Mr. Lindsey, aged about 30, a teacher in the Blind Asylum, 
himself partially blind, who a few hours before had been 
thrown from a wagon upon a hard asphalt pavement. He 
was able to get up and walk a short distance, after the acci- 
dent, only complaining of feeling slightly shocked and con- 
fused. He was conveyed to the asylum, and soon after- 
wards became soporose and partially unconscious. This 
condition gradually increased until coma became complete. 
When I saw him, he was lying on his back in a condition of 
perfect unconsciousness and collapse. His pulse was slow, 
40 in the minute and labored: breathing slow and irregular, 
not stertorous, but at intervals, and for a minute or two at 
a time puffing, almost whistling; pupils neither contracted 
nor dilated, but insensible to light. All attempts to rouse 
him to the least exhibition of consciousness were in vain. 
There was complete relaxation of the whole body, so that 
the presence or absence of paralysis on either side could not 
be determined. He had had before I saw him some convul- 
sive movements on the right side. 
From his right ear there was a free and continuous flow 
of bloody serum. After gently syringing out the ear with 
warm water, I was able with the speculum and mirror to 2 
POOLEY. 
observe a rupture of the anterior inferior portion of the 
membrane tympani. I made the diagnosis of fracture of 
the base of the skull, with extensive hemorrhage. It was 
proposed to administer croton oil, but to this I objected that 
it was incapable of doing any good, and any perturbation 
would be likely to increase the hemorrhage. As he was 
capable of swallowing, though slowly and imperfectly, very 
small doses of brandy and water were directed. A catheter 
was introduced into the bladder, but very little urine was 
found. He died before morning." 
The post-mortem was made 24 hours after death by Dr. 
O. Frankenberg, Prof, of Pathological Anatomy in Starling 
Medical College, assisted by my brother and myself. There 
was slight extravasation of blood under the scalp; immedi- 
ately under the right temporal bone there was a fresh clot as 
large as the spread hand of considerable thickness, and pro- 
ducing a marked depression of the cerebral substance. 
Upon removing the brain, a fissure fracture was found ex- 
tending from the vertex directly through the temporal bone 
and across the base of the skull as far as the foramen mag- 
num. This fracture was joined just above the mastoid pro- 
cess by another and shorter one only two inches in length, 
running upwards and backwards. The fractured portions 
were very slightly movable upon one another. 
The temporal bone, which was carefully removed by 
Lucae's method, was given to me for dissection. It was put 
in Muller's fluid, and examined by Dr. Spitzka and myself 
several months later. The fracture is a fissure. A single 
fissure starts about behind the groove for the middle 
meningeal artery, runs towards the latter, and there divides 
into two. The posterior one of these fissures runs through 
the pyramid of the temporal bone on its anterior superior 
face and nearly parallel with the petrosal crest. This fissure 
is a serrated one. The other fissure is but a continuation of 
the main one. A sector comprising the posterior inferior 
portion of the membrana tympani remains attached to the PATHOLOGY OF THE TEMPORAL BONE. 
3 
posterior fragment. The other and greater portion with the 
intact malleus to the anterior fragment, in which the greater 
part of the Eustachian tube is contained. The chorda tym- 
pani nerve has been torn through, a portion about long 
protrudes from the posterior fragment. The articulation of 
the malleus with the incus is cleanly separated, otherwise 
the chain of ossicles are in their normal position and con- 
nections. Stapes is freely but excessively movable. The 
tear runs along the axis of the auditory canal, in its deeper 
parts, both on its upper and lower walls. In the anterior 
aspect of the deeper part of the canal, the soft tissues are 
separated from the bony walls. The lower scala of the 
cochlea was laid open and found to contain no blood. The 
superior semicircular canal being opened, a clear fluid issued 
therefrom, but it contained no blood. Furthermore, the 
other semicircular canals were opened into by a section 
transverse to the axis of the bone, and all found to be filled 
with a perilymph, but contained no blood. Bristles were 
passed from the canals into the vestibule. 
The special interest which attaches to the specimen, it 
seems to me, is the immunity from injury of the structures 
of the inner ear, which, as is clearly shown, were not in- 
volved in the line of fracture. Of course the injuries which 
are found upon examination of the fractures of this bone 
are naturally very variable. In this instance the damage, so 
far as the structures of the car were concerned, were mainly 
expended upon the middle ear. Especially interesting was 
the complete disarticulation of the malleo-incudal joint, and 
the injury done to the chorda tympani. As we all know, 
the usual result of fracture of the petrous portion is death, 
either immediately from hemorrhage or compression, or later 
from inflammation of the brain or its meninges. That re- 
covery may occur we also know ; although union of the frac- 
ture seldom occurs by osseous consolidation, but more fre- 
quently by fibrous union. 
If the case should not terminate fatally, total deafness is 4 
POOLEY. 
the rule, and this has usually been in such instances attrib- 
uted to the destruction of the inner ear. It is questionable 
whether in such a case as the one now described (if recov- 
ery had ensued) there would be total deafness. Of course 
the amount of violence done to the auditory canal and tym- 
panic cavity would have resulted in a more or less protracted 
purulent inflammation of the middle ear, which would have 
seriously compromised hearing; but with the nervous appa- 
ratus still intact, we cannot conceive that the deafness would 
have been absolute. 
I regret that the opposite side was not examined, to see 
whether the fissure extended through to the other temporal 
bone. For such a case is recorded by Voltolini, (M. f. O., 
1869, s. 110,) to which Schwartze refers in his book. 
Case II. Chronic Otitis Media. Necrosis of Inner Ear, 
Abscess of the Cerebellum. 
September 22, '78, I was consulted by Miss L., 23 years 
of age, on account of an offensive otorrhoea. She had suf- 
fered from earache and otorrhoea since childhood. The dis- 
charge would cease for a time, then after severe pain recur. 
The last attack of this kind, which she says began about four 
weeks ago, was accompanied by distinct cerebral symptoms, 
nausea, vomiting and vertigo. S. P. Face pale and very 
much emaciated, with a chronic cough, and physical evi- 
dences of phthisis pulmonalis. Her mother died of phthisis. 
She complained of constant pain in the ear and vertex. 
There was a slight but most offensive otorrhoea, which suit- 
gested by its smell the presence of diseased bone. She 
complained of a very distressing vertigo which was always 
aggravated when assuming a recumbent posture. There was 
facial paralysis on the same side as the diseased ear. Ex- 
amination of the ear after cleansing, showed a large linear- 
shaped perforation of the anterior inferior quadrant of the 
membrana tympani. The mucous membrane of the promo- PATHOLOGY OF THE TEMPORAL BONE. 
5 
tory, which was fully exposed, pale, and there were several 
spots of hemorrhage upon it, as well as upon the remnant of 
membrane. There was no evidence of any inflammatory 
action in the appearance of the middle ear, nor was the mas- 
toid region either painful or swollen. h=o. v. 
I ventured the diagnosis of extension of the ear disease to 
the brain, abscess of the cerebellum, and made an unfavor- 
able prognosis. The propriety of trephining the mastoid 
was considered, but the operation rejected as not likely to 
do any good, as the extension was evidently not by this way. 
All the symptoms became rapidly worse. The pain was in- 
tense, the vertigo such that the patient thought the bed was 
going round, and although she was excessively weak, she 
assumed an upright posture most of the time for the relief 
to this symptom thus afforded. She retained her conscious- 
ness until only a few hours before her death. Vomiting 
was throughout a very distressing symptom. Death took 
place on the 29th inst., just one week after I first saw her. 
Treatment was merely palliative. Steaming the ear gave 
her more relief than anything else. 
The post-mortem was made 24 hours after death, by Dr. 
Spitzka and myself, in the presence of Drs. Knapp, Cham- 
berlain, Wright and Partridge. 
Upon removing the calvarium, an abscess about the size 
of an English walnut, with a well formed pyogenic mem- 
brane, was found in the left hemisphere of the cerebellum. 
When opened, it gave issue to the most offensive pus. No 
abnormality of any other parts of the brain was found. 
The abscess itself was distinctly circumscribed, and there 
was no softening of the brain substance in its vicinity. 
The temporal bone was removed for dissection. No evi- 
dence of necrosis of the inner surface of the bone could bo 
found, but the part which lay in apposition with the abscess 
was blackened. The temporal bone, which was kept in 
Muller's fluid, was examined by myself and Dr. Spitzka, 
several months afterwards. 6 
POOLEY. 
No evidence of necrosis of the surface of the bone ; that 
poition corresponding to the eminences of the cochlea and 
superior semicircular canals, perfectly normal in consistency 
and appearance. Perforation of the membrana tympani in 
its anterior inferior quadrant. The portion of membrane 
still existing seemed to be only newly formed connective tis- 
sue (probably healed perforation). The auditory canal was 
opened by sawing in an anterior posterior direction, just in 
front of the attachment of the drum-membrane, when a 
small purulent cavity, situated above and behind the tym- 
panum, and communicating with the latter immediately be- 
hind the attachment of the membrana tympani, was laid 
open. No ossicles were present. The mucous membrane 
was thickened and covered the promontory. The latter was 
smooth and healthy. At the posterior portion of the ne- 
crotic bone and purulent mass lies the facial nerve, which is 
softened and diminished in volume, while above this point 
it is quite healthy. The tendon of the tensor tympani was 
attached to the thickened part of the mucous membrane in 
its upper portion. The cochlea was opened into by a strong 
knife. The modiolus was entirely destroyed except at its 
base; the septum between the three coils was preserved. 
The soft parts of the vestibule were entirely wanting. The 
horizontal semicircular canal was absent; the anterior verti- 
cal one contained pus, but was still lined by membrane. 
The superior vertical contained pus, but no lining mem- 
brane. 
The walls of the vestibule and the bony canals were 
smooth and surrounded by ivory healthy-like bone. Both 
the saccule, utricule and superior and horizontal canals ab- 
sent ; membranous part of the anterior canal present, but 
bathed with pus, which extended into the vestibule. A 
bristle passed into the aqmeduct of the vestibule failed to 
reach the surface of the bone. The internal auditory meatus 
was examined; both nerves at this point healthy, all the 
other parts of the canal being healthy. PATHOLOGY OF THE TEMPORAL BONE. 
7 
No trace of a necrotic path communicating with the cavity 
of the skull could be found. The abscess of the cerebellum 
was probably not of recent origin, since it had such a well 
marked thick pyogenic sac. Is it not probable that each of 
the oft recurring attacks of pain, to which the patient re- 
ferred, were due to cerebral irritation which lasted for a few 
days and then passed away, but finally by repeated attacks 
gave rise to the formation of an abscess? 
Another point of interest is the simultaneous existence of 
labyrinthine and cerebellar disease. I made the diagnosis of 
the seat of the intracranial disease from the vertigo and un- 
steadiness of gait. May this, however, not just as well have 
been caused by the disease of the semi-circular canals? 
I am sorry that I did not notice more particularly whether 
the staggering in walking was towards the affected side, as 
this might have enabled me to have included the probability 
of the inner ear being disorganized in my diagnosis. But I 
only saw the patient once before she took to her bed, and 
then forgot to make the inquiry.