never succeeded in rupturing it. But probably no more cruel injustice is done than that which is inflicted in boxing children's ears for "inattention." Children are not inattentive, but distinctly curious and alert, and a child who incurs boxes on the ears on such ground is probably doubly injured: in mind as well as body—by the injustice as well as the hurtfulness of the blow. I have known a youth die of brain disease from inflammation of the ear, whose history was that when young his father used often to box his ears for not attending.

Rupture occurs also sometimes in hanging, and in fracture of the base of the skull. In the latter case, the question whether the liquid that escapes from the ear is cerebro-spinal fluid or not may be solved by chemical and microscopical examination. Once, in removing the petrous bone from the skull in a case in which there had been a fall on the head but no fracture had been discovered after death, a distinct fracture of the bones of the base took place, extending thro' the petrous bone, before any force adapted to produce it had been employed. Is it not possible, therefore, that there may exist a sort of virtual or latent fracture of the base of the skull, in which the continuity is loosened but not distinctly broken, and that this may, perhaps, permanently affect the function of the ear?

Injury to the membrane from explosions of artillery or otherwise are not very frequent. I have seen but one case of rupture from heavy guns; the patient was a naval

officer; the rupture healed and the hearing was regained. Dr. Orne Green* reports several cases of injury to the ear from an explosion of chemical substances. In half of them there was a previous history of slight disease of the tympanum; the injury found was of two kinds: rupture, with or without discharge, soon healing; and a forcing inwards of the membrane, causing deafness and tinnitus, relieved by the introduction of air into the tympanum, and so restoring the membrane to its normal position.

64

In the year 1863 a young woman applied to me, into whose right ear undiluted nitric acid had been poured by accident. The face and the outer part of the meatus. were excoriated by the acid; the hearing seemed almost totally abolished on that side, but the membrane presented only a dull and rather opaque appearance. In the British Medical Journal" for August 2nd, 1873, Mr. Lee reports the case of a man struck by lightning. Among other injuries, there was excoriation of the right auricle and bleeding from the meatus. He was also deaf in the right ear, and on examination by Dr. Allen, a laceration of the membrane was found: pain followed after a fortnight, but was relieved by discharge; the hearing had not returned.

(5). Inflammatory perforation of the membrane sometimes occurs as the result of inflammation of the meatus, tho' much more rarely than from inflammation within

* "Tr. Amer. Ot. Soc.," 1872, p. SS.

the tympanum. One such case I had the opportunity of observing from an early stage.*

The patient was a healthy girl, aged eight years, who had suffered for four years with repeated attacks of discharge from the right ear, often attended with pain, and brought on first by chewed paper put into the ear by a companion. On examination, the meatus was found somewhat red, swollen, and covered with discharge; on the membrane, which was of a dull grey hue, with a purplish tint, besides a general congestion of its vessels, there was, just beneath the end of the malleus, a small red surface, bounded below and in front by a whiter portion of the membrane, apparently a thickened patch of epidermis. This red surface appeared raw and slightly depressed, and had the aspect of a superficial ulceration. The membrane was entire, as proved by the fact that air passed into the tympanum, through the Eustachian tube, moved the membrane forward, but did not pass through it. On the next day, at the anterior extremity of the red patch, a small darker spot was seen, visibly pulsating, and through which, on the inflation of the tympanum, air passed outwards with the usual slight screeching sound. No fluid, however, escaped with the air.

When next seen, eleven days after, the red surface was no longer to be distinguished, the perforation had healed, a slight depressed point alone marking its position; the general aspect of the membrane was much more

* See Atlas, Plate XIX., fig. 3.

transparent than before, and less vascular, but it looked too concave and somewhat irregular. It moved outward on inflation, by which the hearing distance also was improved. The membrane gradually became free from opacity; and the position which was occupied by the red surface appeared as a slightly depressed, thinner, and more transparent portion, resembling a scar, but perhaps yielding less on inflation.

CHAPTER VI.

AFFECTIONS OF THE TYMPANUM.

Acute and Chronic Catarrh: Suppuration.

OUR knowledge of the diseases of the tympanum has greatly advanced in the last few years, especially in the form of bringing into doubt much that has passed current as ascertained. In regarding the subject the surgeon feels like a person suddenly released from bonds to which he had grown accustomed--conscious of a new liberty, but uncertain in what direction it may lead him.

Acute and chronic catarrh, with free exudation, or with dry thickening [sclerosis] of the mucous membrane,

going pathology of the tympanum; but the ill success which attended the treatment of a large class of cases left the mind dissatisfied. And investigations taking in a wider

on to anchylosis, at one time nearly exhausted the

Scope

and

have at least sufficed to show that the range of

aural disease is less contracted than had been supposed, is therefore probably open to a wider application of remedies. In this condition of our knowledge, however, it would be unfit to dogmatize; and I shall endeavour not to mark out the various kinds of disease with definite