PART I, (Part 3)

was an affection of the nerve. Here we see glimpses of de- duction from the anatomical knowledge of the time. Peter Forest, who must have been an Englishman, judging from his name, but who practised in Rome in this century, to whose works Lincke gives no definite reference, collected fif- teen cases of aural disease that seem to have been carefully ob- served. One is a case of disease of the ear, ending in an af- fection of the brain and death. He speaks of pain in the ear caused by the rays of the sun, and he tells a wonderful story of a female deaf for seven years — so deaf that she could not hear a clock strike — who, being advised by that character so common in medical scenes, an old woman, to put some musk in her ear, did so, and was cured. He also tells how his teacher, Gisbert Horst, the director of a hospital in Rome, used to heal deafness with water that was distilled over a young mouse having no hair. We trace one of the delusions that still lingers among us — namely, that the hearing is completely destroyed when the membrana tympani is broken — to a writer named Hercules Sassonia, who lived in this century. He also had the peculiar 3 34: A SKETCH OF THE notion that patients always spoke in a low tone when the disease of the ear was seated in the auditory nerve, because the nerve supplying the tongue, a branch of the fifth, was at the same time- affected. In deafness arising from venereal disease, blisters behind the ear, and a mixture of oil of guaia- cum and hydrochloric acid, as a local application, of which the patient drank a little, were highly spoken of. 1510-1590] The great Frenchman, the father of modern surgery, Ambrosius Pare, figures in otological his- tory as the first one to employ a syringe for cleansing the ear. 1597] Caspar Tagliacottzi, of Bologna, who did so much for plastic surgery, did not neglect the ear, but attempted to restore the auricle by taking integument from the adjacent skin. He relates one case of a Benedictine Monk, where he had done this with success.* 1690] Although the aural speculum had been used a hun- dred years before, we find a certain Johann Hartman very unwilling to use it ; for he seems to advise the detection of inspissated cerumen by the following simple method. He placed a curved silver tube into the ear, and blew through it. If the patient felt the breath to be cold, the deafness did not proceed from impaction of was. In our day the detail of this method is sometimes simplified without altering the principle ; that is to say, a probe is used to see if wax is in the ear. Through all this century, the seventeenth, there are numerous volumes on the treatment of the ear, but they all tread through the barren waste of drops and decoctions, theories, nomenclatures, and rank empiricism. Lusitanus gives an amusing explanation of the practice of cutting off the ears of thieves. He said that such treatment rendered them incapable of propagating their kind, and hence no more thieves could be born of them. He founded this opinion on the statement of Hippocrates that the division of the veins behind the ear rendered a man sterile, because the * The efforts made to instruct and to cure the deaf and dumb, which were first thoroughly incited in this half of the sixteenth century, we leave for a fuller discussion in the chapter on deaf-muteism. PEOGEESS OF OTOLOGY. 35 semen, which was generated in the brain, could no longer pass down to the genitals. Johann Baptista van Helmont, evidently a Belgian, casts away the theory that had so long prevailed, of deafness being caused by ascending exhalations, and clears up the whole matter by ascribing it to the work of the devil, or other evil spirits. 1640] Marcus Banze gives us the first idea of an artificial membrana tympani, by proposing to place a tube of ivory in the auditory canal, the end of which is covered by a bit of pig's bladder, as a protection to the exposed ear, when the membrana tympani was lost by ulceration. 1646] The renowned surgeon, Fabricius of Hilden, or Fabri- cius Hildanus, so called to distinguish him from Fabri- cius of Acqvapendente, contributed somewhat to the surgery of the ear. He invented an instrument for extracting foreign bodies from the ear, as, indeed, every surgeon of eminence seems to have thought it his duty to do. He also wrote of the removal of aural polypi. In the latter half of the seventeenth century, Thomas Willis attempted to prove, by experiments on animals, that total deafness does not ensue when the membrana tympani is destroyed. He also made some interesting observations on deaf persons who only heard in the midst of a noise. Yon Troltsch quotes one of these cases in his text-book,* that of a woman who could only hear her husband when a servant was beating a drum. The conversations in that family were probably not very protracted. This kind of impairment of hearing, which was called paracusis Willisiana, was referred by its describer to a relaxation of the membrana tympani, the normal tension being restored by the noise, or vibrations of the atmos- phere. 1683] Du Verney, known by his labors in the anatomy of the organ, and his work on the diseases of the ear, contributed very little to sound knowledge, although he made an attempt to arrange the diseases in accordance with the anatomy. He, however, disputed the generally accepted opinion that a dis- * Diseases of the Ear, American translation, 2d edition, p. 256. 36 A SKETCH OP THE charge of pus from the ear came from the brain, and showed that the meatus auditorius internus was closed by the auditory nerve, and that the pus must pass through the cochlea and the fenestra ovalis rotunda, before it could get into the exter- nal auditory canal. Du Yerney modified Hippocrates' suggestion to get at a foreign body not otherwise easily removed, by making an opening behind the ear, and recommended that the incision be made upon the upper side, because the vessels are smaller in this position. He thus anticipates Von Troltsch, who made the same modification of the original suggestion nearly two hundred years later.* In the works upon the ear that appear in this century, we still continue to hear much of worms, or living larva?, in the ear — a state of things, however common among the ancients, that is now very rare, because suppurating ears are usually cleansed. The disgusting and magical ear-drops of the early and dark ages are still used in this latter part of the seventeenth century. Thus one writer records that a Capuchin monk mixed the urine of a female donkey, that had brought forth but once, with that of a male hare, of a wolf, or in case of the absence of the latter, of an entirely white goat, warmed it, and adding a little oil of caraway, used it as drops for the ear. Urine of the various animals figures largely among the ear-drops of the period. Paullini, one of the writers of the day, is in doubt, however, whether it is proper that women should use the renal secretion of dogs as a remedy for deafness. We begin to hear more in the latter part of the seventeenth century of the education of the deaf and dumb, but it is min- gled with much that is absurd in attempts at treatment. The great error was then made, as it often is now, of supposing that the diseases of the ear which produced deaf-muteism were of a different nature from those which in the adult caused deafness only. John Wallis, an Englishman, was perhaps the first to in- struct a deaf-mute to speak — which he did, and that very well. The case was one of acquired deaf-muteism, the patient having * Diseases of tlie Ear. American translation, p. 488. PEOGEESS OF OTOLOGY. 37 lost liis hearing at eight years of age ; but he became able to read the Bible aloud, and to converse with some fluency. Lincke begins his account of the progress of otology in the eighteenth century with the lament that it did not keep pace with the anatomical investigations of the organ, which had been brought to such a high point by the labors of Valsalva, Cassebohm, Cotugno, and Scarpa, and he says that Otology would have advanced very much faster had Antoine Marie Valsalva devoted himself more to its prosecution. But Valsalva did much to give us correct notions in regard to the diseases of the ear. He adduced cases where the membrana tympani had been restored. He showed that the hearing power is merely impaired, not lost, by a perforation of the membrana tympani. He recognized anchylosis of the base of the stapes as a. cause of deafness. He gave us the Valsalvian experi- ment, the mode of forcing air through the Eustachian tube by a forced expiration with the mouth and nostrils closed, and he advises it as the best means of cleansing the middle ear from pus. He proved that the cavity of the tympanum is connected to the cells of the mastoid process, by a case in which he injected the former through a fistulous opening in the latter.* He also showed that stoppage of the Eustachian tube is often a cause of deafness. This is certainly a re- freshing catalogue after we have been wading through the disgusting empiricism of the centuries before. Valsalva's century is, however, also cursed with theoretic treatises on aural disease, such as that of one Frederick Hoffmann, who goes on, in the good old way, with instillations of wonderfully compounded ear-drops. Lincke mentions numerous inaugural dissertations of this time, but they relate chiefly to cases that were not properly understood by the re- porters of them ; and these authors, as well as their theses, are deservedly forgotten. 1774] J. L. Petit in a work upon surgical diseases, reports many interesting cases of caries of the temporal bone. In one case of suppuration in the ear, with caries of the mas- toid, he advised that this part should be cut down upon and * As I have elsewhere shown, this case was for a long time supposed to be one of perforation of the mastoid. Vide chapter on the disease of the mastoid. 38 A SKETCH OF THE trepanned. His advice was not followed and the patient died. He also relates cases where this operation was successfully performed, and he must therefore be considered as the origi- nator of this valuable procedure.* 1735] We then come to the famous postmaster of Versailles, Guyot, who first injected the Eustachian tube. His own hearing was impaired, and in order to relieve it he introduced an angular tube of tin through the mouth, opposite fgegenj, not into, the Eustachian tube. The distal extremity of this instru- ment was attached to a leathern tube. This was connected to the reservoir of two small pumps, which were moved by two cranks and a wheel fastened in machinery, by means of which he forced fluid through a curved pewter tube, placed behind the uvula, into, or about, the mouth of his Eustachian tube, and removed the impairment of hearing. 1735] Beck,f who quotes from the Hist, de VAcad. des Sci- ences, thinks that Guyot washed out the mouth of the Eus- tachian tube. We now know that the procedure alone is a very valuable one. I regret very much that I cannot get access to Guyot' s original report to the French Academy. About fifteen years later Archibald Cleland, an English physician, revised the operation of catheterization of the Eus- tachian tube, and introduced a tube through the nose, which was a much more practicable method than that of Guyot. His contemporaries seem to have paid little attention to his suggestions, for Van Sivieten recommends catheterization of the tube through the mouth as a possible operation. Wilde attempts to claim the use of the catheter as a British dis- covery. He makes Guyot a mere suggester of the operation of catheterization, but I think the evidence is in favor of the French postmaster. 1755] Jonathan Wathan, an English author, reported cases of restoration of hearing by means of catheterization of the tube through the nose. His paper is in the Philosophical Transactions of the Eoyal Society. He seems not to have known of Cleland's labors in the same direction. * For a full account of the operations on the mastoid, see the appropriate chapter in this work. ■j- Die Krankheiten des Gehoerorganes, 1827, p. 21. PROGRESS OF OTOLOGY. 69 Archibald Cleland still farther advanced the science of otology by introducing a three-inch convex lens, with a han- dle, as a means of examining the ear. The ear was illumin- ated by a waxlight attached to the lens. 1748] Julian Busson proposed, in rather an undecided way, to perforate the membrana tympani, in order to remove collections of pus from behind it ; but, as this was a very dan- gerous operation, he advised the inhalation of vapors through the mouth and nose, and then that they be forced into the Eustachian tube by means of Valsalva's method, as he thought that the pus might thus be driven out of the middle ear. The surgeons, after the seemingly complete failure of phy- sicians to successfully treat diseases of the ear, animated by the invention of the Eustachian catheter and Petit's operation for perforation of the mastoid, seem to have been exceedingly active in otology during the latter half of the eighteenth cen- tury. Antoine Petit, as well as Cleland, recommended the use of an instrument through the nose instead of through the mouth, as proposed by Guyot, and injections through the tube are everywhere recommended in their writings. The successful cases which were reported about this time were usually among young persons. The reason that the Eustachian catheter fell into such disrepute can be found in the fact, that it was used in chronic cases, in which the prog- nosis should have been pronounced bad or hopeless from the beginning, and a natural disappointment occurred from the want of success. One very careful soul who seems to have been in great hor- ror of the operation, proposed that patients upon whom the catheter was to be used should have the hairs of the nostrils removed, and a day before the operation that lukewarm milk, or a linseed-meal mixture, or the like, should be drawn into the nostrils, so as to make the parts more pliable. 1792] The operation of perforation or trephining the mas- toid process fell into great disrepute because a Danish surgeon, Berger, caused it to be performed upon himself, and very improperly, for " deafness which had been years in occurring, and which was accompanied by vertigo, headache, and noise in both ears." Meningitis resulted, and the pa- 40 A SKETCH OF THE tient died in a few days. This put a stop to the performance of this very useful and necessary operation, until it was lately revived, chiefly by German and American surgeons. 1800] Everard Home,* by his writings, suggested to Sir Astley Cooper the operation of perforation of the mem- brana tympani, which the great English surgeon performed successfully in four cases. The history of the rise and fall, and revival of this operation will be found in the chapter on chronic non-suppuration of the middle ear. John Cunningham 8aunders\ wrote a work on the ear, its anatomy and diseases, which went through several editions in England, and one in America. It is a brief, but scientific treatise, and far beyond its pre- decessors. It is characterized by simplicity, and is without the absurdities of the older text-books. It is deficient in de- scriptions of the methods of examining the drum-head, and teaches the erroneous doctrine that it is proper to probe a membrana tympani to see if it be intact. It should be remembered that Saunders advised paracen- tisis of the membrana tympani in cases of acute suppura- tion of the tympanum^: — an operation that was revived by Schwartze a few years ago. He says : "But let it be admitted that the tympanum has suppurated, ought the membrana tympani to be abandoned to a casual ulceration, or is it better to open it by art ? I am inclined to prefer the latter, and if I can be assured, by any symptom, that suppuration has taken place, I should not hesitate to make a small perforation of the membrana tympani, and to repeat it, if necessary, taking, at the same time, every precaution to suppress the fresh collection of matter." Saunders speaks wisely against the objections made to checking a purulent discharge from the ears, and shows that disease of the brain is very apt to follow a neglected chronic suppuration, and he gives some interesting illustrative cases. * Philosophical Transactions, 1800. \ The Anatomy of the Human Ear, &c. Edited by Wm. Price, M.D., Philadelphia, 1827. X Ibid., p. 59. PROGEESS OF OTOLOGY. 41 The book is very deficient in its treatment of the Eustachian tube. Thus early do we find, in spite of Cleland's and Wa- than's teachings, the English prejudice against the use of the catheter, which has only lately been overcome. 1817] J. H. Curtis also published a book on the ear,* but it added nothing to our knowledge, being a feeble imita- tion of the work of Saunders. 1819] J. A. Saissy, of Lyons, devoted the last twelve years of his life to the study of aural disease. He published a work on the ear, which attained the honor of a place in the "