INJURIES OF THE EAR
BMJ (Clinical Research Edition)
REVIEWS MTIlEBRmsN MEDICAL JOURNAL a mature and finished piece of work-a research on the commissures of the mammalian brain. Being in contact with Professor J. T. Wilson, Almroth Wright, and C. J. Martin in those early years in Sydnev, he acquired from them the best technique then available for microscopical work on the brain-more than students could then obtain in England. It was certainly Elliot Smith who introduced into British Anatomy modern methods of brain research. His predecessors
... ched the problems of the human brain by giving their attention to the form and size of its outer aspect, whereas Elliot Smith's intuition led him straight to its deepest and oldest parts-the commissures and the olfactory bulb and lobe. His predecessors began with the human brain and then worked down the animal scale; he began low down in the animal scale and worked upwards, and so came by a clear perception of the sequence of events which ended by giving man his predominant brain. From 1894 to 1907 papers on the brain ca.me in rapid sequence. In 1907 new items began to appear on his list of literature. He had then been teaching anatomy in the medical school at Cairo since his arrival in Egypt in 1900. Until 1907 he resolutely refused to be drawn from his prescribed course of brain research. Circumstances proved too strong for him. We find him becoming involved in the study of the ancient Egyptians-first of their bodies and then of their civilization. With most men a "new love " means a break with the " old love." But this was not so with Elliot Smith; he added subject to subject, and kept a " harem " of research going with ease. The places held by Lord Rutherford and Sir Grafton Elliot Smith have been " filled," but their successors would be the last to claim that they had replaced them. Both advanced knowledge; both had the power to impart their gifts of mind to apt pupils; yet I feel persuaded, and the study of this life of him by old comrades and pupils has deepened my conviction, that coming generations will be interested in Elliot Smith not because of his discoveries, but because of the man he was-a man of a rich, peculiar, and lovable personality. I might have quoted passages from Stopford, Wood Jones, or H. A. Harris to bring out this personal aspect of his life, but I have refrained, leaving the enjoyment of these passages to the readers of Elliot Smith's biography. Traumatismes de l'Oreille. By J. A. Ramadier and R. Causse. (Pp. 150; 15 figures. 45 fr.) Paris: Masson et Cie. 1937. In their small volume on injuries of the ear Dr. Ramadier and Dr. Causse group the subject-matter under four headings: (1) injuries of the external ear, tympanic membrane, and middle ear; (2) fractures of the temporal bone; (3) gunshot wounds; and (4) concussion of the labyrinth. They provide in addition a description of the examination, both clinical and pathological, required for medico-legal report or evidence. A most important section deals with the light which has been thrown upon fractures of the skull by histological examination of the petrous portion of the temporal bone. Fractures of the temporal bone can be roughly divided into longitudinal and transverse varieties; while the oblique combines some of the characters of both, the longitudinal variety being the more common. In the longitudinal variety the line of the fracture descends from the squamous portion of the temporal bone across the tegmen tympani and middle ear and then passes along the anterior aspect of the pyramid. The tympanic mem-brane is ruptured, but the internal ear and the facial nerve escape injury. The transverse variety is a fracture of the labyrinth and passes across the cochlea, and often the facial nerve is injured either at the internal auditory meatus or in the aqueduct of Fallopius. The inner or labyrinthine wall of the middle ear may be injured, but the tympanic membrane remains intact. Nager has shown histologically that in transverse fractures the capsule of the cochlea may be cracked like an eggshell from such an injury, although there is no naked-eye evidence of the fracture. If the patient recovers from a longitudinal fracture no dangerous sequel is to be feared, but after a transverse fracture the barrier between the middle ear and the internal ear is permanently impaired. Even a mild attack of otitis media is then liable to extend through the internal ear to the meninges. Thus a longitudinal fracture, which tears the tympanic membrane, is associated with some immediate risk of intracranial infection, whereas a transverse fracture with intact tympanic membrane puts the cavity of the tympanum into communication with the subarachnoid spaces at the internal auditory meatus, and heals in such a way that for the rest of his life the patient is in danger of meningitis should the middle ear become infected. The interval in recorded cases may be as short as twenty-eight days (Scheibe) or as long as fifteen (Brocq) or even sixteen (Schlittler) years, but the sequel is now proved to be a direct though remote consequence of the original injury, not a mere coincidence, and such a conclusion has been accepted by insurance companies. The information contained in the book might have been provided more concisely, but the matter is readable and is of prime importance in relation both to the management of head injuries and to the problems of compensation which arise later.