NOTES AND OBSERVATIONS ON SOME OF THE MORE REMEDIABLE CASES OF DEAFNESS
BMJ (Clinical Research Edition)
1WQrIA M COMUNCATIONS. aU led X casew, nor the antdt. I have no doubt that w ha suffee fom srlet feve. C ia v. Maer B. had carlet fever when a child, in which he nearly died from ear and brain disease. Some months after recovery, I saw him, then perfectly deaf. The membrna tyimpami were both removed by ulceration, as well as the ossicula. A portion of cochlea was likewise shown me, which had escaped from the ear-copious dis-chwrUe from a spongy mucous membrane. The membrane was unproved;
... as unproved; otorrhoea lessened, and at length removed. He gradually lost his speech, and is now being educated as a deaf-dumb. CASB VIII. A physician writes me as follows:-" MJy two children, aged respectively 11 and 13, were six weeks past attacked with scarlatina anginosa, very intense and protracted; the throat affection accompanied with severe inammation of the mucous lining of the mouth and nostrils, and spreading to the nasal ducts, and affecting the eyes. Of course the Eustachian tubes partook, and complete deafness in both eases ensued. The suppuration from the ear has been considerable and foetid, but not having at all the smell of decaying bone; and I have accurately marked the discharge, without being enabled to detect more than a puriform discharge, acrid enough to excoriate the external ear and cheek, but unaccompanied by blood or sanies. The statement of one will serve for both, as no deviation is perceptible." I found in both ears of the boy that the membrana tympani was entirely removed. The malleus remained in situ, entirely stripped of its coverings, yet attached to the granulations of the mucous lining of the cavity. Otorrhoea considerable. The speech was gradually being lost; and I believe he is being taught as a deaf-mute. The case of the sister was as nearly similar as could be. In these cases, I think there can exist little doubt that the labyrinth or the nerve in its track must be affected. CASE X. Joseph Seamons, a.ged 9, had scarlet fever very dangerously four years ago, and has had discharge from the right ear ever since. The membrana tympani is extensively ulcerated. An abscess formed over the right mastoid process, which was insufficiently opened. A fistulous ulcer communicates between this opening and the posterior surface of the auditory meatus, from which a vascular fungus projects into the auditory canal. CASE xi. Louisa Eames, aged 17, had scarlet-fever seven or eight years ago. A large polypus grows from the mucous lining of the tympanic cavity of each ear, and completely occupies the meatus. CASE xii. Miss M. J., aged 15, has been deaf ten or eleven years, in consequence of severe scarlet fever, which endangered her life. The deafness gradually increased, accompanied with considerable discharge of a foetid matter, of variable consistence, with formerly occasional bleeding; discharge and bleeding likewise from the nose. The general health now tolerable. The membranie tympanorum removed by ulceration, except a small portion at the upper part. The mallei and inCi both lost, and possibly also the otapedes; mucous membrane hypertrophied; meatus moderately healthy, though secreting a thin fluid; tonsils and fuauces healthy. 2, Harley Street, Cavendish Sqnare. "Ir aural diseases were as attentively studied in these kingdoms as ophthalmic or obstetric affections, then would the lengthened description of cases be unnecessary; but where do wre find throughout the whole circle of our pen-odical literature half a dozen well obsered and aeeuratey noted cas of disse of the ear in a twelTemonth I Fait& ful observation and clinical records of dises are now muer required in this than in any other branch of medical science." Fully concurring in the opinion thus expresed by one of the ablest aurists of the present day (Mr. Wilde), I venture to lay before the profession the followingc trusting that they may in some measure supply this want. They are plain and faithful records of what I actually saw and observed; nothing is stated on mere conjecture; when I have fairly seen a part, I have described as accurately as possible its appearance; if an unsatisfactory view was obtained, I have stated so in the notes. Every case, therefore, as far as it goes, may be relied on for accuracy; the truth has always been told, though possibly not the whole truth, because the necessary examinations to arrive at it, either coul(inot be made, or, having been made, the information sought for could not in every instance even then be obtained. It may be thought by some that the researches of Mr. Toynbee in the department of aural surgery have made us so fully acquainted with the pathology of diseases of the ear, that further illustrations are unnecessary. Without, however, any disparagement to this distinguished aurist, the value of whose labours no one can appreciate more fully than myself, I must observe, that hitherto they have been confined almost exclusively to an elucidation of the morbid changes found in the ear after death; while the symptoms which these changes gave rise to during life, the exact amount of deafness which this or that lesion occasioned, we are left in ignorance of. The association of the symptoms with the lesions is, therefore, still a desideratum, which it is hoped this contribution may furnish. In many of the cases reported, there will be found the identical changes in the organ of hearing, whnich Mr. Toynbee's dissections have revealed; while data are supplied relative to the amount of improvement of which the diseased organ is susceptible. CASE I. Acute IIanmraation of the ifembrana Tympani of both Ears brought on by Cold; Great Deafness, Severe Pain, Loud Tinnit?m, followed on the second day 6il discharge; Right Membrana Tympani covered with Florid Granulations; Left Ecchymosed; Eustachian Tube of the Left Ear ob8tructed; Treatment by Leeches, Blisters, A4e- rients, and afterwards an Astringent Lotion; Heartng restored. John Bradford, aged 46 years (cook), applied to me on the 14th July, for relief from a purulent discharge affecting both ears, and accompanied with pain, a high degree of deafness, and a constant buzzing and ticking tinnitus. On washing away the discharge, by means of a, syringe the membrana tympani of the left ear was less lucent than in the healthy state, but was otherwisi not remarkable; the membrana tympani of the right ear could not be seen, owing to flocculi of lymph, which I was unable to detach with the syringe; on gently touching it, however, with a probe, great pain was excited. HISTOV.j-Eight days ago he caught cold, which, as he said, "stopped up his ears". This was soon followed by severe paiin in both ears, accompanied by a humming and blowing, and various odd sounds. The pain continued to increase in severity, when it was considerably relieved by a discharge, which broke forth from both ears on the second day of the pain, just after the application of some leeches; the buzzing and deafness, however, remained undiminished. When the tinnitus first came on, and for some time afterwards, he could not dispossess himself of the idea that the noises proceeded from without; and the delusion was so strong, that he, two or three times, jumped out of bed to see whence they proceeded. He said that he had enjoyed good health; but thirty years ago he had a similar attack, which was got rid1 of without impairment to hearing. Hirudines vi, pone aures sing. -statim applic. Habeat haust. cathart. omni miiane. July 15th. The leech-bites bled freely, and the patient was much relieved. He felt lighter in the head, and slept better last night than he had done since the attack.