CHAPTER XIV.

NERVE-DEAFNESS-HEREDITARY SYPHILIS- -AFFECTIONS OF

THE EAR IN INDIA.

In this section we approach the darkest part of our subject, and one which owing to the structure of the organ must, so far as we can anticipate, always remain a region for inference rather than for demonstration. It presents to us a demand for extreme patience; and even for suspicion of apparently the best founded means of investigation. For instance, we have seen that the apparently certain test of the tuning fork-its being heard louder in the worse ear in tympanic affections, and louder in the better ear in nerve-affections-has many exceptions. And with regard to the morbid conditions of the nervous apparatus, though dissection has made known to us the occasional presence of many, hardly one of them has yet been connected with characteristic symptoms, and their most formidable signs are sometimes simulated by mere external conditions that give rise to pressure on the membrane.

But, notwithstanding these disadvantages, we may fairly claim a certain amount of knowledge, and it is steadily increasing. In the first place, the morbid con

ditions which have been found on dissection of the labyrinth are the following:

Mr. Toynbee found the auditory nerve diseased twelve times-eight times atrophied, twice with blood effused around it, once suppurating, and once having a tumour attached to it. Disease of the labyrinth he observed one hundred and five times; most frequently atrophy, thickening, deficient endolymph, excess or deficiency of otoconie, deposits of pigment or calcareous matter, exostoses, the endolymph opaque or red, or the blood-vessels enlarged.* He has also seen hæmorrhage into the labyrinth after the poisons of gout, and various fevers.

Politzer also has found ecchymoses accompanying ecchymoses of the tympanum.

Voltolini found most frequently thickening of the membranous structures, cretaceous deposits, deficiency and excess of otoconie, deposit of pigment, amyloid degeneration of the auditory nerve, once a fibroid tumour in the cupola of the cochlea, and once a sarcoma of the nerve. † He found increase of the otoconie one of the first and most common morbid conditions. Förster has also reported sarcoma of the auditory nerve, and Dr. Böttcher has observed deposits of phosphate of lime infringing on the internal auditory canal.

In my own dissections I have found more or less decided morbid conditions of the nervous structures by no

"Medico-Chirurgical Transactions," vol. xxxviii.

Von Troeltsch, "Ohrenheilkunde," 3rd edition, p. 384.

means very uncommon. enlargement and congestion of the vessels of the labyrinth, often of a very extreme degree. This I have observed forty-one times, and chiefly in connection with inflammatory affections of the tympanum. Excluding cases of deaf-dumbness, I have found the membranous labyrinth obviously atrophied sixteen times, soft and swollen ten times, and seeming fatty twice the endolymph opaque or red seventeen times, seeming too abundant three times, and too scanty twice; the otoconie in apparent excess five times, and in apparent deficiency eight times; twice the labyrinth has contained pus, and once cholesterine ; once the sacculus had undergone bony degeneration; once the lamina spiralis was thick; once the cochlea contained a fibroid mass, three times an excess of pigment, and twice extravasated blood.

Most frequent has been an

*

Gruber has found anæmia and hyperæmia of the labyrinth; inflammation of it, and especially, as he considers, a primary inflammatory affection of it in syphilis, attended with giddiness, &c.; extravasated blood; new formations epithelial and cellular; fibrous adhesions in the vestibule ; cholesteatoma; cancerous growth; chalky deposit in the meatus internus; absence, atrophy and degeneration of the auditory nerve.

Gruber also lays stress upon the frequency with which labyrinth affections are secondary to tympanic ones, and

Lehrbuch der Ohrenheilkunde," Wien, 1870, p. 611.

observes that the secondary nerve-affection may remain permanent tho' the tympanic affection disappears.

In time these conditions may become recognizable during life; the sooner, doubtless, the more carefully unproved assumptions are abstained from.

Perhaps the best ascertained connection of organic lesion of the tympanum with definite symptoms is in the form of disease known as Ménière's disease, or labyrinthine vertigo. This affection has received its name from having been first observed by Ménière, in the case of a girl who caught cold while menstruating, became suddenly deaf, suffered from giddiness and vomiting, and died on the fifth day. No disease was found except a bloody exudation in the canals and vestibules. The symptoms, of course, appear the more easily intelligible thro' the experiments of Flourens, so often repeated, which show marked disorder of motion to result from section of the semicircular canals.

These cases seem to occur very frequently, and have been studied in their general relations, among others, by Dr. Hughlings Jackson. The following is a characteristic

case:

Great deafness on the left side, beginning after attacks of vertigo and faintness three years ago; tinnitus twelve months; tympanum healthy.

D. W—, æt. 50, a perfectly healthy man and of healthy family, with no tendency to deafness. About three years ago he had fits-five or six, at short intervals-of giddiness and vomiting, which he had never

suffered from before. He staggered, and thought he was bilious. On such occasions he recovered in a few hours. His medical attendant stated that the fits were like fainting; and he ascribed them to overwork. They reminded him of sea-sickness. They mostly came on in the evening, and in the morning the patient was well. There was nothing to draw attention to the ears, but during their occurrence the medical man noticed him to be deaf on the left side. The patient did not discover this till afterwards. After two years, about twelve months ago, a singing noise in the ear came on suddenly, and has continued ever since; there were no fits or giddiness at that time, but he had been worried. The membrane is perfectly healthy, and to all appearance the cavity of the tympanum. Throat healthy. With the right ear closed, only words spoken in a loud voice near the left ear are heard. Watch (about four feet hearing distance) not heard. The tuning-fork on the teeth heard well, but only on the right side. Music sounds natural. On exhausting the air in the external meatus, so as to draw the membrane outwards, the tinnitus was decidedly diminished for a few minutes.

In this case no cause was apparent beyond the overwork. In the one that follows, a diseased condition of the osseous wall of the canals suggests itself :

Frequent giddiness and vomiting, with staggering and tendency to turn to the left in walking; deafness of each ear; restricted perception of musical sounds; no apparent disease of tympanum; old disease of

sternum.

N. W, æt. 51, first seen in July, 1871; of moderately healthy family, free from, tendency to deafness, but of strumous constitution; a widower seven years; never syphilis, until a mild form three years ago, which appeared to have no influence on his other symptoms. Since he was a child (he believes ever since measles) he has had ulcerated swellings over the sternum and two or three of the ribs of the right side, frequently discharging; no bone has, to his knowledge, come away. For many years,

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