ON SOME OF THE FUNCTIONS OF THE MIDDLE AND INTERNAL EAR: AND THEIR ANALOGIES.

8 in some other forms, the contraction of the opponent is a deavour to indicate, with as much perspicuity and brevity formidable impediment to the functional restoration of the as are in my power, some of the more offices muscle that is weakened; and the anatomical relations of which the various parts in the tympanum perform in transthe recti tendons to the capsule of Tenon are fortunately mitting sonorous vibrations to the fluid in the internal such that an effectual tenotomy, if carefully performed, will ear. not involve any loss of power likely to produce displacement The manner in which the terminal extremities of the in an opposite direction. It is always satisfactory to obtain auditory nerve spread out upon the delicate membranes of some evidence of reaction to the current before the tenotomy the labyrinth, receive the undulationof sound, and commuis performed, because then eventual success may be con- nicate their effects to the sensorium, has lately been elucisidered certain ; but there will be some cases in which the dated by the minute dissections and microscopical investi. paralysed muscle will be too feeble to react until released gations of Kblliker, Schultze, Henle, Czermak, Hulschke, from the tension of its antagonist. and others, and will be subsequently adverted to. The adI am disposed to attach importance to the small rheo- vance in knowledge of the structure and functions of the phores, and to their application on the conjunctival surface, labyrinth seems necessarily to lead to the conclusion that immediately over the affected muscle; so that 11 locahse the great end and intention of the tympanum (its more imelectrisation" maybe practised after the manner of Duchenne. mediate accessory part) are to modify, extend, and multiply There can be no doubt that an induced or faradaic current the various sounds which are conducted through it; whilst is more generally applicable than the direct current to the by its position, form, communications, and contents, it acts as a protective organ, and renders the internal ear quite incases under consideration, because less potent in its effects upon the optic nerve and retina; and, as a rule, for the dependent of the vicissitudes of atmospheric temperature. same reason, I should use the primary induced current beIncidentally I may remark that this last preservative office fore having recourse to the secondary. The latter, as the is not sufficiently regarded bya,ural surgeons in their theramore penetrating, may be used if the former should fail; peutical treatment. To relieve a catarrhal obstruction in but on account of the very superficial situation of the recti, the tympanum, I have frequently witnessed the introduconly a small power of penetration will usually be required. tion of cold air and lotions into its cavity, through the Furthermore, since it has been shown that in some cases Eustachian tube catheter, both being, according to my paralysed muscles will react to the direct current when they views-in which I am glad to find myself supported by the eminent aurist. Dr. Von Troltsch,—injurious rather than are insensitive to the induced, the former should in all cases be tried, but with due caution, as a last electrical resource, curative agents. If we put the pathological anatomy of the and prior to the performance of any operation for shortening ear under strict examination, we shall, I think, be soon convinced that the greatest number of cases of deafness the weakened muscle. arise from disease of the cavity of the drum and its apPrinces-street, Hanover-square, Dec. 1868. pendages. The hindrances to sonnd-conduction may be occasioned by simple mucous accumulation, by thickening of the lining mucous membrane (which is also a periosteum, and every inflammation of it therefore constitutes a periosON SOME OF THE FUNCTIONS OF THE titis) lessening the degree of motion in the chain of ossicles, MIDDLE AND INTERNAL EAR: AND and giving rise to adhesions between each other, or to the THEIR ANALOGIES. parietes of the tympanum. If these conditions be neglected, further morbid alterations will take place : rigidity of the BY PETER ALLEN, M.D., F.R.C.S. EDIN. whole ossicular chain, extending to the membrana tympani externally, and to the fenestra ovalis internally, causing WHILST attention has of late been increasingly bestowed the base of the stapes to become more or less fixed to its surface, may result. This last affection, anchyupon the mode of investigating and treating diseases of the articulating losis of the stapes, which is so likely to supervene upon reear, and great advance made in aural pathology, there can peated attacks of aural catarrh, advances insidiously -with be little question that our present physiological knowledge the patient’s age, until no vibrations are able to be transof the more important parts of the organ of hearing, is mitted to the vestibule by the ossicular course, and the tymneither comprehensive nor accurate. The space allowed me panic air ceases to influence the labyrinthine fluid, in conin THE LANCET will not admit of even cursory reference to sequence of the necessarily fixed condition of the membrane of the fenestra rotunch. This disease was always formerly, the laborious researches and experiments on physiological and is frequently now, confounded with affections of the acoustics pursued by German and other continental aural auditory nervous apparatus; and Dr. W. Kramer, at one surgeons; it must, therefore, be presumed that my readers period of his practice, estimated that his cases of nervous are somewhat acquainted with the results of their inquiries, affections exceeded fifty per cent., whereas now, owing to our advance in pathological science, their frequency is reduced as recorded in the several periodicals devoted to their to four in a thousand.* Weeprnot, however, yet quite credit spcmKe. It is much to be regretted that more unanimity such marvellously increasing powers of diagnosis. Neverof opinion does not prevail; indeed, it is curious to observe theless, we assuredly may diagnose rigidity of the ossicles, how importantly one writer will modify the ideas of another or anchylosis of the stapes, by careful attention to the investigator without himself arriving at more exact or satis- symptoms accompanying their progressive stages, by the of loss history of the case, and by observing the factory inductions. The somewhat contradictory and, at present, irrecon- which the patient has sustained over, what I term, the p01Vm" cileable views entertained by both English and German of adjttstiiig the ear to receive certain vocal or other sounds. I shall subsequently point out that this power of adjustphysiologists in reference to the actions of parts within the ment results from the mode of attachment, position, and and internal to the ear, seem to have suggested tympanum late learned President of the Medico-Chirurgical Society voluntary action of the stapedius muscle, affording to my a most close analogy to the ciliary muscle of the (Dr. Alderson) the following observations, which were con- conception when, as in predaceous birds, that muscle is eye, especially sequent upon a discussion on the last paper ever presented inserted into osseous plates in the sclerotic, as strong and Mr. 1866:8th, Toynbee, May byH massive as are the crura of tHe stapes. He (the President) thought much more would be gained To to our more immediate subject. An accurate by the close study of physiology as introductory to patho- study return of the functions normally performed by the tympanum Whilst we were with logical investigation. fully acquainted the mode in which light was impressed upon the retina, and and its contents, will therefore be the only safe guide in dethe exact locality of the diseased alteration. It so communicated to the brain, notwithstanding that doubt termining is not intention at the present time to enter upon a demy still existed as to the true theory of the nature of light ; tailed anatomical or physiological description of the middle whilst on other the vibrations of the the air were hand, yet, internal divisions of the hearing apparatus. I am now fully understood, very little that was positive had been as- and desirous of throwing additional light upon certain simply certained as to the mode in which those vibrations were communicated to the brain."—Ve THE LANCET, June 16th, important points which have hitherto escaped notice, or have not been sufficiently elucidated.

important

Degree

1866. Under these circumstances, I have undertaken to en-

*

"Ohrenheilkunde

der Gegenwart,"

p. 39. Berlin, 1861.

9 or otherwise, really interested in the wish to who recall their knowledge of the anatomy subject, and general functions of this complex organ, will find the best résumé of the subject in Mr. Wharton Jones’s and Dr. Todd’s essays in the Cyclopsedia of Anatomy." Although this treatise was published thirty years ago, its general accuracy, as far as knowledge of aural science then extended, cannot be impugned; and perhaps the best testimony to its excellence as an anatomical guide is the re-appearance of most of the engravings and diagrams as illustrations to Professor Owen’s last volume on " Comparative Anatomy and Physiology"(article Hearing) just issued from the

Those, students

"

press. In

reflecting upon

the

physiology

of the

tympanum

whole, and upon the perfection with which all its

ponent parts

are

arranged

for the purposes of

as a

com-

receiving,

intensifying, and transmitting the aerial vibrations which impinge upon its external membrane, I am surprised to find that no physiological writer seems ever to have entertained the notion that the cavitas tympani contains air that has been respired. There is most conclusive evidence to show that in tranquil respiration the tympanum is usually closed against the ingress, through the Eustachian tube, of air respired or unrespired, of gases from the stomach, or even sounds generated in the fauces or mouth; yet, under certain

normally-performed muscular actions, the

air is permitted to enter and to escape from the interior of the tympanum in such proportions as may be requisite for maintaining the same tension on the inner as on the outer side of the membrana tympani. Without such arrangements for renewal and equalisation of air, the requisite vibratility of the tympanic membrane could not be maintained the air would become exhausted or absorbed, the membrane and ossicles would fall inwards, causing pressure upon the vestibular fenestra and labyrinth fluid: a condition attended with great diminution of hearing-in fact, all the symptoms usually depending upon an abnormal obstruction of the Eustachian tube would result. Besides the strong presumption that the tympanum, with its mastoid cells, would contain air already heated to an appropriate temperature, and fitted to circulate in and against delicate fragile structures in close proximity to the interior of the cranium, the idea receives confirmation by a personal experiment, which doubtless almost everyone has at one time or another unwittingly performed. This test is best applied out of doors on a cold day, for reasons which will appear obvious. Try to remove an irritant or adhesive mucous secretion from the upper and back part of the palate and fauces by repeated suction of air through the nose, with the mouth closed; you will put into action the levator palati muscle, by which the arch of the palate will become raised to some extent, and the inner wall of the Eustachian tube drawn apart from the outer ; and if at the same time an attempt be made to ,yawn, with the mouth closed or only partially opened (paradoxical as this act may seem), the tensor palati will be also put on the stretch, and the Eustachian tube still more widely opened by its outer wall being drawn apart at every fresh suction of air through the nostrils (the glottis being raised in this inspiratory movement), and cold, very appreciably cold, air will be drawn into the tympanum. At this point, I cannot refrain from observing that by this experiment, as well as in further explanation of acoustic phenomena, Mr. Toynbee’s strongly reiterated opinion, now generally accepted, that the Eustachian tube is only opened during an act of deglutition, is proved incorrect. (To be continued.) -

ON POISONING BY TINCTURA FERRI PERCHLORIDI. BY J. W.

WARBURTON, M.R.C.S.E.

THERE being, I believe, no case of poisoning by the above tincture on record, and but few by hydrochloric acid taken alone, I am induced to give the nt)tes of a case attended by me on Dec. 5th last. The patient, Mrs. R-, aged thirty, in rather delicate health, had by her an ounce bottle of steel drops," which she was taking by medical advice. Previous to the occurrence "

now related the bottle was full, and she had not taken any food for about seven hours. At 4 P.M. on the day named, Mrs. R after a quarrel with her husband, in a fit of passion, swallowed the whole contents of the bottle, with a view to commit suicide. She continued well for about a quarter of an hour, when violent convulsions aBecting’ the whole body came on. I arrived a short time afterwards, and found her lying on a sofa: face somewhat flushed, eyes injected, pulse small and accelerated; unable to speak, and apparently unconscious. A little mustard-and-water had been given her without effect. Another spasm soon came on, during which the body was much contorted; the muscles of the extremities contracted violently, and the teeth were clenched and ground together. She required to be restrained upon the couch, and her hold upon those near her could not be unloosed until the spasm suddenly ceased. She then appeared free from pain, but was only partially conscious, and continued unable to speak. After some little difficulty in opening the mouth, I gave her a sulphate-of-zinc emetic, with plenty of warm water. As this did not act, and the spasms recurred, in the next interval I repeated it, this time tickling the fauces with a feather. Copious vomiting ensued, of a clear, reddish-yellow fluid, evidently containing a considerable amount of tincture of iron, with a little I may here remark that the duration of the attacks mucus. was about two minutes, that of the intervals three. After the vomiting, immediate relief was experienced; no more spasms came on, and she rapidly recovered the use of her faculties and limbs. Half an hour after the sickness she had an attack of diarrhoea,, with black stools, which soon ceased. At 9.30 P.M. the patient felt quite well, with the exception of some soreness and stiffness of the limbs. The chemist who supplied the 11 steel drops" told me it The symptoms of was the Tinc. Ferri Perchloridi, B.P. irritant poisoning in the above case were doubtless caused by the free hydrochloric acid, which is always present, more or less, in tincture of iron. Holland-place, Edgehill, Dec. 14th, 1868.

A Mirror OF

THE

PRACTICE

MEDICINE

AND

OF

SURGERY

IN THE

HOSPITALS

OF

LONDON.

Nulla autem est alia pro eerto noscendi via, nisi qiiamplurimas et morborum et dissectionum historias, tum aliorum, tum proprias collectas habere, et inter tie comparare.—MORGAGNI De Sed. et Caus. Morb., lib. iv. Procemium.

UNIVERSITY COLLEGE HOSPITAL. TYPHOID

FEVER ; PERITONITIS;

PERFORATION OF

ABDOMINAL

(Under the

INTESTINE ;

LOCAL

ABSCESS DISCHARGING THROUGH

care

WALL ;

RECOVERY.

of Sir WILLIAM JENNER.)

PERFORATION of the bowel, in typhoid fever, is computed occur in about 13 per cent. of cases of the disease terminating fatally. A patient, who is now in this hospital, and whom we saw a few days since, has sustained this accident under circumstances which were unusually favourable to him, and of very peculiar character. It is known that occasionally a local peritonitis in connexion with the base of an ulcer may cause adhesion of the bowel to a neighbouring coil of intestine, and so a circumscribed abBut in scess may form, discharging itself into the bowel. the case to which a brief reference is here made, the inflamed intestine has apparently attached itself to the peritoneal lining of the abdominal wall, and the abscess resulting from perforation, circumscribed by this adhesion, has opened externally through the parietes. We are indebted to Dr. Squarey, the resident medical officer, for some particularsof the case.

to