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PRACTICAL OBSERVATIONS ON THE PATHOLOGY AND TREATMENT OF DEAFNESS. No. IV.
777
’
will consent to be kept quiet, and take low diet, she mav live a considerable timethat is, considerable compared with the time she would live, if she were to walk about. The other two patients admitted were men ; one laboured under peritonitis, the other under acute rheumatism.
irregular determinations of blood to parts of the body, and disordered nervous action. In these cases it is probable that an over.secretion of mucus from recipwith
different
rocal diseased action of the mucou3 membrane lining the tube of Eustachius may often preclude the approach of sounds to the internal ear by that avenue. I do not think that the deafness in these cases is always caused by local obstruction, for there is a sense of tumult in the head, a confused and muddled state of mind, and conPRACTICAL OBSERVATIONS ON THE comitant noise in the ears. I published the PATHOLOGY AND TREATMENT following remarks five years ago on this subject:--’ But in different individuals the OF in this disease (the morbus mucohearing DEAFNESS. sus) is powerfully acute, whilst in the ad. vanced stages some are almost deaf. The No. IV. deafness is not always caused, as one would By JOHN FOSBROKE, M.D., Cheltenham. at first suppose, by obstruction in conseaccumulated in the quence of mucus IN cases of deafness, with obstruction of Eustachian tubes, or of occlusion of their the Eustachian tube, the indistinctness of pharyngeal apertures, for they have been sounds and noises in the deaf ear are increas- pervious to inflation, when, in the more aded apparently by the impulse of the air on vanced stages of the disease, the acoustic the membrane of the tympanum being ren- sense was greatly impaired. According to dered more forcible from without, than when observation, both sight and hearing shall be that membrane is counterpoised by the free preternaturalty acute, or preternaturally dull access of air from the mouth of the Eusta- in this disease, at different periods of its adchian tube to the cavity of the tympanum. vancement. When the eyes are morbidly But the continuance of this noise after the susceptible, and noise and tumult in the external auditory canal is plugged, shows head are complained of, the hearing at such that it is owing but partially to this cause. times is more dull and confused. It must Incapability of distending the membrane be remembered that in diseases which inof the tympanum by closing the mouth and volve the whole constitution, as well as parnostrils, and expiring forcibly, is no certain ticular parts, of the human fabric, the ears, proof of permanent obstruction of the Eus- as possessing an eminent degree of organic tachian tube, where that difficulty has oc- sensibility, take a prominent place as to curred, and also where plugging of the mea- original suseeptibilitv." * tus externus has rendered the patient comIt is a curious circumstance, that in these pletely deaf,I have passed properly-curved mucous cases, those nerves are chiefly, inprobes with the greatest facility from the deed primarily, affected, which arise from nostrils into the cavity of the tympanum. and about the tuber annulare, viz., the fifth When the Eustachian tube is clear, the deaf pair, which supplies the appendages of the ceitainly hear best through the mouth, per- eyes, nose, teeth, and parts about the face, haps because the cavern of the mouth and and the eighth and ninth (portio mollis and the nasal cavities cause the sounds to come dura), the nerves of the parts of hearing and louder from that direction. But, also, in- expression. ability to hear through the mouth is not In 1822, Mr. M., a general practitioner, always a proof of permanent obstruction of came to Dr. Jenner on his own account, the Eustachian tube, for I passed the probes having the mucous disease with deafness. into the middle cavity of the ears of a gen- The deafness could not be traced to obstructleman, whose membrana tympani Sir A. tion of the Eustachian tube, or of the meatus Cooper had punctured, and who " could not auditorius, by inference from symptoms or always hear a watch when placed in his the usual tests. He had a painful and permouth." A patient may be able to perflate manent lieadach, great dejection of mind, the tympanum at one time, and not at ano- torpor of habit, and every symptom incident ther. Dry and fine weather is most favour- to those who pass vitiated mucus from the able for it. bowels. His mind had been under the inApparent obstruction of the Eustachian fluence of the depressing passions some tube occurs very frequently in those cases of years. I attribute his deafness to the dimideafness which are connected with that state nution of energy which the sense of hearing, of chronic disease which consists in con- as well as the brain and nervous system, had tinued and vitiated discharges of mucus from the mucous membrane of the bowels, Pathology of the Kidneys, p. 107. 162.5.
being
778 in consequence. August, 1822, examples, of hepatitis and hemiplegia, ani I took these notes just as they stand, two return as those complaints were diminished;" years before I paid any particular attention [These facts agree with a case of deafuess to the subject of deafness. In June, 1825, disappearing on the occurrence of a thoracic Mr. M. called on me at Cheltenham ; his affection, which I have already related, and hearingand constitution had improved, but are instances of John Hunt6T’s doctrine, that the susurrits aurium continued. " two actions," &c.-F." secondly, enThere appears to be a morbid condition of tirely cease in twoinstances, the Eustachian tube of the same nature, hours before death ; and thirdly, which is purely local. In such cases I have cured for more than a year of the remainder found the Eustachian tube sometimes closed, of life by an accidental hæmorrhage from the sometimes open, sometimes extremely irri. humeral artery. This species of deafness is table when touched with a probe, at others very commcnly produced by colds in the possessing little sensibility. The more irri- head, in which it is evidently owing to a table the membrane may be, so much the communication of disorder from the mouth greater is the sense of cold and torpor of and nose along the membrane, which is con. hearing. In such cases the membrane is tinued into the Eustachian tube. It is prolax and thickened, and clammy with an bable, however, that, on many occasions of albuminous mucus, as far as I can judge deafness, the malady is not confined to this from the introduction of the probe, and from part ;but it is worthy of inquiry, whether, observing this condition of the soft palate at in such cases, the effect does not originate the same time. Dr. Parry describes a spe- in a similar excessive impulse of blood acting cies of deafness which he thinks cannot be on some other essential pat of the organ of ." imputed to torpor of the nervous system, the hearing being at one time dull, at another of nervous influence, and loss too acute. * This species is connected with of animal heat, are observed, in cases of a morbid condition of the Eustachian tube. DEAFNESS WITHOUT DISCHARGE, in the tiS. " There is a common species of deafness," sues which line the Eustachian tubes, as says he, " of which Dr. James Sims has well as in those of the external auditorv spoken, if not first, at least best, in an egnel- passage. At the same time, the Eustachian lent memoir read before the Medical Society tube may be excessively irritable tothe touch, of Edinburgh. Like many other disorders and more irritable on one side than the of circulation, it is usually called nervous. other. Obstruction of the Eustachian tube It, however, seems evidently to arise from rarely occurs unconnected with other causes obstruction of the Eustachian tube. Accord- of deafness. M. Lallemand describes otor. ingly, when it is simply of this kind, the pa- rhoea of the Eustachian tube as the most tient can hear well, when the tube is dis- rare and insidious variety of inflamma. tended by strong blowing, with the nose, tion of the ear with discharges. Dull mouth, and cheeks closely shut. He can pain in the aural region, fixed or shifting, usually also, at all times, hear acute sounds, constant or intermitting, tinnitus aurium, but not the more grave ones. In this case, in a buzzing or cascade-like form; hardness there is so far from being any real paralysis of hearing, increased to complete deafness, of the nerves that acute or very low sounds succeeded by sudden recovery, the two last are even painful, and what demonstrates phenomena being ascribed to the accumu. that this is a disease of increased vascular lation and discharge of matter from the fulness, or impetus, t and not of nervous tympanum ; a bitter taste, fmtid breath, nau. sensibility, is, that I have known it first sea, vomiting, expectoration, or violent removed on the occurrence, in the respective coughing up of fœtid matter; distaste of food, loss of appetite, emaciation and de* After hysteria, phrenitis, and some other dis- spondency, caries of the bones, cerebral eases, the hearing is often too acute ; the nerve is affection, and death, mark the progress of sometimes morbidly sensible after apoplectic affec- the affection. The disease is generally astions, which appears to denote too great fulness of cribed to the stomach and lungs, and treated the vessels of the head. A case of morbid irritability of the auditory nerve following an 11 poplectic sciz tire, accordingly without effect. is related in the London Medical and Physical The ceruminous glands in deafness are Journal, about 1822. The late Dr. Jenner was generally torpid, or cease entirely to secrete, similarly affected after his first apoplectic seizure, and incapable of hearing any " clicking," or sharp and, sometimes, instead of healthy wax, sounds without flushing of face, determination to a thin fluid. The of the head, and great pain, for he sometimes put both produce his hands up to his head and rushed out of the room. their secretion is said to cause deafness. It ceased a few days before his death, which arose I have known audition become gradually im. from a second apoplectic seizurei whilst sitting in paired at the same time that the wax be. his chair and shaving. came very hard, nodulated, and small in + Here, and in the remainder of the sentence, Dr. quantity, whilst there was, at the same i’, introduces his favourite doctrine, but I am not convinced that the facts cannot be as well expjained time, some chronic soreness of throat, and in another way. pain in the course of the Eustachian tube,
undergone
forty-ei;ht complettIv
.
hearing Diminution
suspension
779 seen these glands much narrow and angular course towards the m. t. irritated by any mechanical stimulus ; hence These changes may increase the reflection Professor Macartney conceives it best to of sound from angle to angle, and concen-
To many cases I have
let them alone when diseased. It is sup- trate the impressions into a narrower focus at posed that the secretion of these glands isthe drum. Ambrose Pare has a poetical of the passage of sound as affected intended to prevent the intrusion and collision. " Such a collisioig is spread I do not believe the asserson of insects. tion, for numbers of persons whom I have:over the air as the water, which, by the known having dry porches experienced no ;gliding touch of a stone, produces many and rings, one as it were rising from such accidents. It is more probable that So as in rivulets running in a the moisture has something to do with the as conduct of sound ; in functton, as well in narrow channel, the water stricken, health as in disease, they appear to act in were, beaten back in its course against concert with the other Darts of the organ. broken, craggy, and steep rocks, whirls Destruction of the membrane of the tym. about into many turnings, the collision of panum causes different degrees of deafness, the beaten air flies back divers ways from which are incurable. Cold air and moisture acute and hollow roofed places." obtaining, in consequence, ready admission into the delicate interior structure of the ear, render the individual more obnoxious to catarrhs. The preservation of the interNEW MINERAL RESIN. nal ear from the effects of cold is a most important use of this intercepting mern- , THE last Number of Brewster’s Edinbrane. Deafness, when owingto this in- burgh Journal, contains an interesting nojury, mav exist without noise in the head, tice by Mr. J. F. W. Johnstone, of Portoexcept during the catarrh. Mr. Cruik- bello, of a substance which he describes as shanks observes, that when the membrane a new mineral resin, and which occurs is perforated the hearing is irrecoverably amongst the refuse of an old lead mine in lost, for the air, getting through the breach, Northumberland. The author describes the so affects the delicate periosteum and mus- mineral in the following terms :cles of the bones and the pulpy sacs, that: " Colour.—Externally, red ot various the parts are rendered unfit to perform theirshades, black, and sometimes pale yellow, functions, though in the same page he ad- approaching to the colour of amber. Intermits that the membrane has been destroyed, nally, red, or brownish-red, except in the and that the small bones have come away vellow varieties, and by transmitted light of without destroying the sense. I have seen a brilliant deep-red colour. It yields to the three cases in which it was destroyed by knife, but is hard, brittle, and has a bright external violence or disease : all these par- glassy small conchoidal fracture. The fragties were deaf. A girl of the name of Drum, ments are transparent, and the fractured st. 24, became deaf at the age of four years, surfaces exhibit a pale greenish tinge (an in consequence of violent cold and sore throat. opalescence), which becomes more decided The catarrh was attended with a discharge after the lapse of a few weeks; the transfrom one of the ears, which-she could not parency at the same time diminishing in a say. She had always noise in the ears when slight degree. The specific gravity varies labouring under a cold. The membrane of from 1.16 to 1.54 in the dark-red varieties. the tympanum had an old ulcerated open- In the flame of a candle it burns with consi. ing, through which, when affected with derable smoke, and an aromatic, slightly catarrh, she inspired, but not at other times. empyreumatic, odour, leaving a small coaly On the right side the Eustachian tube was residuum. On the sand bath, in a close permeable, and the m. t. uninjured. Both tube, it gives off a small quantity of a transears secreted healthy cerum. Cold injec- parent, colourless, and highly volatile naphtions caused violent heat and noise in the tha, having a peculiar odour, resembling ears. Alteratives, counter-irritants, stimu- that of some kinds of strong clieese. Heated lants of ammonia and volatile oil, in shurt to 400°, it does not melt, but assumes a every means failed to benefit her hearing. bright black colour, though, when broken A boy was brought to me from 1’resburgh, into fragments, it still transmits a rich red near Cheltenham, who had produced his light. Over a spirit-lamp it fuses, gives off a deafness by partial destruction of the m. t. colourless naphtha, a red empyreumatic oii, by introducing substances into the external and leaves much charcoal. It is insoluble porch, and exciting inflammation and ulcer- in water, and is very slightly acted on by ation. alcohol or ether. By hot concentrated nitric Patients frequently observe that the ex- acid, it is slowly, but entirely dissolved. ternal auditory tube becomes contracted in When rubbed, it exhibits strong negative deafness. It seems certainly to undergo electricity. Dr. Brewster informs me, that, some change of form, to wind in a like amber, it has no no crystalline struc-
poi.!bytheory
circles
I another.
Iit
I
I more
and,
_
780 This substance occurs along with parts of the city, were instructed instaroy brown spar (carbonate of iron), and carhon- to report the name and residence of the in. ate of lime, either in the form of little drops dividuals seized with it, to the police officers on the surface of the brown spar, where of the different quarters of the town, who, oil cavities occur in the vein, or in the midst of their part, had orders to send the physician the massive brown spar, as if it formed part in waiting at the office, or if absent to find of the solid stone. In one specimen it rests one. At first it was whispered that the upon carbonate of lime, containing crystals doctors and the council were making a of Galena, and is covered with a mass of greater noise about the cholera than the but a few days showed case demanded ; brown spar." On the probable origin of this substance, that it was not by any means a needless Mr. Johnston offers some plausible specula- alarm that had been sounded. In two or tions favourable to the Huttonian or pyrog- three days accounts poured in upon us from nostic theory concerning the formation of all quarters, from which it appeared that the disease was of a much more mahgnant and primary strata. He then observes : " The only mineral resin resembling the alarming nature than the claolerca in 1823. present, of which I have seen any descrip- Some were cut off almost instantaneously; tion, is the mineral copal, or Highgate resin, many in the course of two hours ; and with found at Highgate in blue clay. The latter, the exception of such as had been instantly however, melted by heat into a limpid fluid, bled, it was said that most of those who had a character which shows it to differ very been seized with it expired. On Wednesday much from that above-described. Aug. 4, being the sixth day of the cholera, " The vegetable origin of amber seems it made its appearance in the Mission House, The col- in the case of our friend Mr. Becker; on now established beyond dispute. I found him in great agony, often lection of embalmed insects belonging to the University of Upsala, or the equally splendid convulsed in a most extraordinary manner; private collection exhibited by Dr. Berendt, he was seized about four o’clock, and in a of Dantzick, at the late meeting in Ham- few minutes past ten he expired. The next burgh, appearing sufficient of themselves to of our friends who fell a victim to the choconvince ’the most sceptical. Yet it is not lera, was Mrs. L—. She was seized that the occurrence of resinous about nine o’clock on Saturday evening, and substances like the foregoing, whose origin died in about twenty-four hours. Her hus. is incontrovertibly mineral, should be suf- band, Mr. L- (Serepta commissioner), ficient to lend plausibility to the opinion, died in the course of three or four days after, on his that amber is of mineral origin also." way to Serepta Colony, to which he We believe the generic term of bitumen was conducting his three motherless cliil. would be more appropriate to this substance dren ; his death took place on the side of the than that of resin, inasmuch as one essential public road, three stages from Astrachan. character of the latter class of compounds, On Monday morning Mr. J. S., who is now viz. solubility in alcohol, is here absent. recovered, was reported to us as having been seized. I instantly called down, and was happy to find that having been bled with success, and taken other precautions, his DREADFUL RAVAGES OF THE CHOLERA situation was not peculiarly alarming. About MORBUS IN ASTRACHAN. mid-day the governor’s son was seized with THOUGH the cholera had made its appear- it, and expired before the close of day. The ance at the mouth of the Volga about six death of the governor’s son on Monday was weeks ago, it was not till Friday the 30th followed by that of the governor himself of July, that its beingactually in the city was the same disease on Saturday. ascertained. No sooner was this made Having thus given you a sketch of the liroknown to the public authorities, than a gress of the cholera in the circle of our En. council was summoned to make the neces- glish and German friends, &c., in their indi. sary arrangements for giving all possible vidual or family capacities, permit me to medical aid, and directions to such as might bring the scene before you as a whole, be seized with it. Papers were instantly which the progress of the cholera preprinted and circulated, with a statement of sented to our view. In general, business of the precautions to be taken for avoiding the every kind was at a stand; the bank susdistemper, and a sketch of the means of cure pended its operations ; in the bazaar not a to be employed in the first instance, till whisper was to be heard, and scarcelr a medical assistance could be procured, with face to be seen ; even the cabacks (tippling a list of the names and places of residence houses) were abandoned, and a general of all the physicians in town : and that no gloom was spread over the countenances of delay might be occasioned among the poor the few solitary individuals that were to be who had not servants at command, the senti- seen walking through the streets. Thsis nels, who are stationed night and’day in all gloom was heightened by their attituceture.
calling,
surprising
781
moving pensively along with handkerchiefs at their noses, perfumed with or containing
ON THE ASSOCIATION OF MEDICAL PRACTI-
TIONERS AT NEWCASTLE, AND THE ESTAinfection with BLISHMENT OF SCALES OF MEDICAL FEES. which, it was supposed by medical gentlemen, the air was in a manner saturated. According to the best’accounts, when the To the Editor of THE LANCET. disease was at its height, the number of on was and one particular day SIR,—When I invoked the assistance (f funerals 500, More than a thousand your pen in support of the objects of the on another day 480. were buried about that time in a large sand- Association of General Practitioners estabin this place, you will readily believe pit for want of graves, which could not be lished got dug so fast as required, nor at a rate that t anticipated not your opposition instead that the poor could afford to pay for them, of your support; that I little expected you twenty-five rubles being demanded for each. to designate the principle of our proceedings Such a time we have never seen, nor do I unsound, and to impute to us the very es. suppose that such a time was ever before sence of monopoly. I have to thank you, On the roads leading to however, for the readiness with which you seen in Astrachan. the burial-grounds which are out of the city have given a place in your Journal to the I sent you ; and though I scarcely any-thing was to be seen from with some coufidence, that on the morning to night but funeral processions. generally it will make a very difDuring its progress more than sixty officers, from the governor of the city, the com- ferent impression from that expressed by mander of the fleet, &c. downwards, fell yourself, yet knowing as 1 do the influence victims to it, and the number of the dead of of your opinions on many of its members, all descriptions in the city alone (the resi- I feel myself called upon to endeavour, dent population of which is not more than either to alter your view of the subject by 40,000), is calculated at about 6000 indivi- farther explanation, or to neutralise the duals, besides 1000, or, according to some, effect it is calculated to produce in preventnearly 2000 of those from the interior of ing the adoption of the course recommended Russia, that were passing the summer here, by other practitioners throughout the kingand fled to the towns and villages up the dom. It does appear to me strange to acVolga, in the hopes of escaping it. Of these, cuse the Association of monopoly, when, by above forty were found lying on the road one of its fundamental laws, every legal side unburied ou the first three stages, till practitioner is not only admissible, but is notice was-given of the circumstance to the actually invited to become a member; and commanding officer of the district. But the surely you would not recommend us to ingreater part of the fugitives who fell victims vite the St. John Longs of the neighbourto it, met their fate on the Volga. Nearly hood to join our fraternity. Where then is 10,000, it is said, left the city in great con- the monopoly ? It is as extended as the fusion, and being ill-provided with food and numbers of practitioners at least (and they other necessaries, were reduced to such in- are certainly not a few), and I am at a loss describable hardships on their passage up to know how its basis can be more extensive the river, that Calmucks, on its banks, or more liberal ; it is neither our wish to would have no intercourse with them. It is limit the existing’ number of practitioners said that one or more of the crews of these nor to prevent their increase. On the score boats perished entirely from the cholera, of monopoly then I am able to see no want and having none left to man them, were at of soundness in the prnieiplf. But you say, last carried down the stream with the resi- ’° It is further unsound, in its being an endue of the dead on board, and that in other deavour to estimate the value of mental From the acquirement and skill by the gross inefficient cases the ravages were dreadful. above statements it would seem that a sixth test of a metallic standard." Base, indeed, or seventh part of the population of Astra- would be the attempt (mulerialist as I may chau, chiefly adults, have been cut of by the be) to bring the intellectual exertions of a cholera ; and it is supposed that the one high and noble mind into comparison with half of the adults have been more or less the glittering dross which is too frequently affected by it. Some children that were the effective stimulus to human efforts, and seized with it died ; but the proportion of which has unfortunately become the medium these in comparison of adults was small. of compensation for all human services. It Mr. J. S-’s youngest child died of it, is indeed a subject of deep regret that it after been abandoned by its nurse. should be so ; and of yet deeper regret that The cholera is now as far up the Volga asI medical practitioners, however exalted may Saratoff, and as far west as Kieb.—Abridged be their principles of action-however generous and philanthropic, and disinterested from tlte Scot.111is. and Phil. Register. their desire to save life and to relieve suffering—that those humane and enlightened
camplior,
to couuteract the
communication
hope,
profession
having
’
will consent to be kept quiet, and take low diet, she mav live a considerable timethat is, considerable compared with the time she would live, if she were to walk about. The other two patients admitted were men ; one laboured under peritonitis, the other under acute rheumatism.
irregular determinations of blood to parts of the body, and disordered nervous action. In these cases it is probable that an over.secretion of mucus from recipwith
different
rocal diseased action of the mucou3 membrane lining the tube of Eustachius may often preclude the approach of sounds to the internal ear by that avenue. I do not think that the deafness in these cases is always caused by local obstruction, for there is a sense of tumult in the head, a confused and muddled state of mind, and conPRACTICAL OBSERVATIONS ON THE comitant noise in the ears. I published the PATHOLOGY AND TREATMENT following remarks five years ago on this subject:--’ But in different individuals the OF in this disease (the morbus mucohearing DEAFNESS. sus) is powerfully acute, whilst in the ad. vanced stages some are almost deaf. The No. IV. deafness is not always caused, as one would By JOHN FOSBROKE, M.D., Cheltenham. at first suppose, by obstruction in conseaccumulated in the quence of mucus IN cases of deafness, with obstruction of Eustachian tubes, or of occlusion of their the Eustachian tube, the indistinctness of pharyngeal apertures, for they have been sounds and noises in the deaf ear are increas- pervious to inflation, when, in the more aded apparently by the impulse of the air on vanced stages of the disease, the acoustic the membrane of the tympanum being ren- sense was greatly impaired. According to dered more forcible from without, than when observation, both sight and hearing shall be that membrane is counterpoised by the free preternaturalty acute, or preternaturally dull access of air from the mouth of the Eusta- in this disease, at different periods of its adchian tube to the cavity of the tympanum. vancement. When the eyes are morbidly But the continuance of this noise after the susceptible, and noise and tumult in the external auditory canal is plugged, shows head are complained of, the hearing at such that it is owing but partially to this cause. times is more dull and confused. It must Incapability of distending the membrane be remembered that in diseases which inof the tympanum by closing the mouth and volve the whole constitution, as well as parnostrils, and expiring forcibly, is no certain ticular parts, of the human fabric, the ears, proof of permanent obstruction of the Eus- as possessing an eminent degree of organic tachian tube, where that difficulty has oc- sensibility, take a prominent place as to curred, and also where plugging of the mea- original suseeptibilitv." * tus externus has rendered the patient comIt is a curious circumstance, that in these pletely deaf,I have passed properly-curved mucous cases, those nerves are chiefly, inprobes with the greatest facility from the deed primarily, affected, which arise from nostrils into the cavity of the tympanum. and about the tuber annulare, viz., the fifth When the Eustachian tube is clear, the deaf pair, which supplies the appendages of the ceitainly hear best through the mouth, per- eyes, nose, teeth, and parts about the face, haps because the cavern of the mouth and and the eighth and ninth (portio mollis and the nasal cavities cause the sounds to come dura), the nerves of the parts of hearing and louder from that direction. But, also, in- expression. ability to hear through the mouth is not In 1822, Mr. M., a general practitioner, always a proof of permanent obstruction of came to Dr. Jenner on his own account, the Eustachian tube, for I passed the probes having the mucous disease with deafness. into the middle cavity of the ears of a gen- The deafness could not be traced to obstructleman, whose membrana tympani Sir A. tion of the Eustachian tube, or of the meatus Cooper had punctured, and who " could not auditorius, by inference from symptoms or always hear a watch when placed in his the usual tests. He had a painful and permouth." A patient may be able to perflate manent lieadach, great dejection of mind, the tympanum at one time, and not at ano- torpor of habit, and every symptom incident ther. Dry and fine weather is most favour- to those who pass vitiated mucus from the able for it. bowels. His mind had been under the inApparent obstruction of the Eustachian fluence of the depressing passions some tube occurs very frequently in those cases of years. I attribute his deafness to the dimideafness which are connected with that state nution of energy which the sense of hearing, of chronic disease which consists in con- as well as the brain and nervous system, had tinued and vitiated discharges of mucus from the mucous membrane of the bowels, Pathology of the Kidneys, p. 107. 162.5.
being
778 in consequence. August, 1822, examples, of hepatitis and hemiplegia, ani I took these notes just as they stand, two return as those complaints were diminished;" years before I paid any particular attention [These facts agree with a case of deafuess to the subject of deafness. In June, 1825, disappearing on the occurrence of a thoracic Mr. M. called on me at Cheltenham ; his affection, which I have already related, and hearingand constitution had improved, but are instances of John Hunt6T’s doctrine, that the susurrits aurium continued. " two actions," &c.-F." secondly, enThere appears to be a morbid condition of tirely cease in twoinstances, the Eustachian tube of the same nature, hours before death ; and thirdly, which is purely local. In such cases I have cured for more than a year of the remainder found the Eustachian tube sometimes closed, of life by an accidental hæmorrhage from the sometimes open, sometimes extremely irri. humeral artery. This species of deafness is table when touched with a probe, at others very commcnly produced by colds in the possessing little sensibility. The more irri- head, in which it is evidently owing to a table the membrane may be, so much the communication of disorder from the mouth greater is the sense of cold and torpor of and nose along the membrane, which is con. hearing. In such cases the membrane is tinued into the Eustachian tube. It is prolax and thickened, and clammy with an bable, however, that, on many occasions of albuminous mucus, as far as I can judge deafness, the malady is not confined to this from the introduction of the probe, and from part ;but it is worthy of inquiry, whether, observing this condition of the soft palate at in such cases, the effect does not originate the same time. Dr. Parry describes a spe- in a similar excessive impulse of blood acting cies of deafness which he thinks cannot be on some other essential pat of the organ of ." imputed to torpor of the nervous system, the hearing being at one time dull, at another of nervous influence, and loss too acute. * This species is connected with of animal heat, are observed, in cases of a morbid condition of the Eustachian tube. DEAFNESS WITHOUT DISCHARGE, in the tiS. " There is a common species of deafness," sues which line the Eustachian tubes, as says he, " of which Dr. James Sims has well as in those of the external auditorv spoken, if not first, at least best, in an egnel- passage. At the same time, the Eustachian lent memoir read before the Medical Society tube may be excessively irritable tothe touch, of Edinburgh. Like many other disorders and more irritable on one side than the of circulation, it is usually called nervous. other. Obstruction of the Eustachian tube It, however, seems evidently to arise from rarely occurs unconnected with other causes obstruction of the Eustachian tube. Accord- of deafness. M. Lallemand describes otor. ingly, when it is simply of this kind, the pa- rhoea of the Eustachian tube as the most tient can hear well, when the tube is dis- rare and insidious variety of inflamma. tended by strong blowing, with the nose, tion of the ear with discharges. Dull mouth, and cheeks closely shut. He can pain in the aural region, fixed or shifting, usually also, at all times, hear acute sounds, constant or intermitting, tinnitus aurium, but not the more grave ones. In this case, in a buzzing or cascade-like form; hardness there is so far from being any real paralysis of hearing, increased to complete deafness, of the nerves that acute or very low sounds succeeded by sudden recovery, the two last are even painful, and what demonstrates phenomena being ascribed to the accumu. that this is a disease of increased vascular lation and discharge of matter from the fulness, or impetus, t and not of nervous tympanum ; a bitter taste, fmtid breath, nau. sensibility, is, that I have known it first sea, vomiting, expectoration, or violent removed on the occurrence, in the respective coughing up of fœtid matter; distaste of food, loss of appetite, emaciation and de* After hysteria, phrenitis, and some other dis- spondency, caries of the bones, cerebral eases, the hearing is often too acute ; the nerve is affection, and death, mark the progress of sometimes morbidly sensible after apoplectic affec- the affection. The disease is generally astions, which appears to denote too great fulness of cribed to the stomach and lungs, and treated the vessels of the head. A case of morbid irritability of the auditory nerve following an 11 poplectic sciz tire, accordingly without effect. is related in the London Medical and Physical The ceruminous glands in deafness are Journal, about 1822. The late Dr. Jenner was generally torpid, or cease entirely to secrete, similarly affected after his first apoplectic seizure, and incapable of hearing any " clicking," or sharp and, sometimes, instead of healthy wax, sounds without flushing of face, determination to a thin fluid. The of the head, and great pain, for he sometimes put both produce his hands up to his head and rushed out of the room. their secretion is said to cause deafness. It ceased a few days before his death, which arose I have known audition become gradually im. from a second apoplectic seizurei whilst sitting in paired at the same time that the wax be. his chair and shaving. came very hard, nodulated, and small in + Here, and in the remainder of the sentence, Dr. quantity, whilst there was, at the same i’, introduces his favourite doctrine, but I am not convinced that the facts cannot be as well expjained time, some chronic soreness of throat, and in another way. pain in the course of the Eustachian tube,
undergone
forty-ei;ht complettIv
.
hearing Diminution
suspension
779 seen these glands much narrow and angular course towards the m. t. irritated by any mechanical stimulus ; hence These changes may increase the reflection Professor Macartney conceives it best to of sound from angle to angle, and concen-
To many cases I have
let them alone when diseased. It is sup- trate the impressions into a narrower focus at posed that the secretion of these glands isthe drum. Ambrose Pare has a poetical of the passage of sound as affected intended to prevent the intrusion and collision. " Such a collisioig is spread I do not believe the asserson of insects. tion, for numbers of persons whom I have:over the air as the water, which, by the known having dry porches experienced no ;gliding touch of a stone, produces many and rings, one as it were rising from such accidents. It is more probable that So as in rivulets running in a the moisture has something to do with the as conduct of sound ; in functton, as well in narrow channel, the water stricken, health as in disease, they appear to act in were, beaten back in its course against concert with the other Darts of the organ. broken, craggy, and steep rocks, whirls Destruction of the membrane of the tym. about into many turnings, the collision of panum causes different degrees of deafness, the beaten air flies back divers ways from which are incurable. Cold air and moisture acute and hollow roofed places." obtaining, in consequence, ready admission into the delicate interior structure of the ear, render the individual more obnoxious to catarrhs. The preservation of the interNEW MINERAL RESIN. nal ear from the effects of cold is a most important use of this intercepting mern- , THE last Number of Brewster’s Edinbrane. Deafness, when owingto this in- burgh Journal, contains an interesting nojury, mav exist without noise in the head, tice by Mr. J. F. W. Johnstone, of Portoexcept during the catarrh. Mr. Cruik- bello, of a substance which he describes as shanks observes, that when the membrane a new mineral resin, and which occurs is perforated the hearing is irrecoverably amongst the refuse of an old lead mine in lost, for the air, getting through the breach, Northumberland. The author describes the so affects the delicate periosteum and mus- mineral in the following terms :cles of the bones and the pulpy sacs, that: " Colour.—Externally, red ot various the parts are rendered unfit to perform theirshades, black, and sometimes pale yellow, functions, though in the same page he ad- approaching to the colour of amber. Intermits that the membrane has been destroyed, nally, red, or brownish-red, except in the and that the small bones have come away vellow varieties, and by transmitted light of without destroying the sense. I have seen a brilliant deep-red colour. It yields to the three cases in which it was destroyed by knife, but is hard, brittle, and has a bright external violence or disease : all these par- glassy small conchoidal fracture. The fragties were deaf. A girl of the name of Drum, ments are transparent, and the fractured st. 24, became deaf at the age of four years, surfaces exhibit a pale greenish tinge (an in consequence of violent cold and sore throat. opalescence), which becomes more decided The catarrh was attended with a discharge after the lapse of a few weeks; the transfrom one of the ears, which-she could not parency at the same time diminishing in a say. She had always noise in the ears when slight degree. The specific gravity varies labouring under a cold. The membrane of from 1.16 to 1.54 in the dark-red varieties. the tympanum had an old ulcerated open- In the flame of a candle it burns with consi. ing, through which, when affected with derable smoke, and an aromatic, slightly catarrh, she inspired, but not at other times. empyreumatic, odour, leaving a small coaly On the right side the Eustachian tube was residuum. On the sand bath, in a close permeable, and the m. t. uninjured. Both tube, it gives off a small quantity of a transears secreted healthy cerum. Cold injec- parent, colourless, and highly volatile naphtions caused violent heat and noise in the tha, having a peculiar odour, resembling ears. Alteratives, counter-irritants, stimu- that of some kinds of strong clieese. Heated lants of ammonia and volatile oil, in shurt to 400°, it does not melt, but assumes a every means failed to benefit her hearing. bright black colour, though, when broken A boy was brought to me from 1’resburgh, into fragments, it still transmits a rich red near Cheltenham, who had produced his light. Over a spirit-lamp it fuses, gives off a deafness by partial destruction of the m. t. colourless naphtha, a red empyreumatic oii, by introducing substances into the external and leaves much charcoal. It is insoluble porch, and exciting inflammation and ulcer- in water, and is very slightly acted on by ation. alcohol or ether. By hot concentrated nitric Patients frequently observe that the ex- acid, it is slowly, but entirely dissolved. ternal auditory tube becomes contracted in When rubbed, it exhibits strong negative deafness. It seems certainly to undergo electricity. Dr. Brewster informs me, that, some change of form, to wind in a like amber, it has no no crystalline struc-
poi.!bytheory
circles
I another.
Iit
I
I more
and,
_
780 This substance occurs along with parts of the city, were instructed instaroy brown spar (carbonate of iron), and carhon- to report the name and residence of the in. ate of lime, either in the form of little drops dividuals seized with it, to the police officers on the surface of the brown spar, where of the different quarters of the town, who, oil cavities occur in the vein, or in the midst of their part, had orders to send the physician the massive brown spar, as if it formed part in waiting at the office, or if absent to find of the solid stone. In one specimen it rests one. At first it was whispered that the upon carbonate of lime, containing crystals doctors and the council were making a of Galena, and is covered with a mass of greater noise about the cholera than the but a few days showed case demanded ; brown spar." On the probable origin of this substance, that it was not by any means a needless Mr. Johnston offers some plausible specula- alarm that had been sounded. In two or tions favourable to the Huttonian or pyrog- three days accounts poured in upon us from nostic theory concerning the formation of all quarters, from which it appeared that the disease was of a much more mahgnant and primary strata. He then observes : " The only mineral resin resembling the alarming nature than the claolerca in 1823. present, of which I have seen any descrip- Some were cut off almost instantaneously; tion, is the mineral copal, or Highgate resin, many in the course of two hours ; and with found at Highgate in blue clay. The latter, the exception of such as had been instantly however, melted by heat into a limpid fluid, bled, it was said that most of those who had a character which shows it to differ very been seized with it expired. On Wednesday much from that above-described. Aug. 4, being the sixth day of the cholera, " The vegetable origin of amber seems it made its appearance in the Mission House, The col- in the case of our friend Mr. Becker; on now established beyond dispute. I found him in great agony, often lection of embalmed insects belonging to the University of Upsala, or the equally splendid convulsed in a most extraordinary manner; private collection exhibited by Dr. Berendt, he was seized about four o’clock, and in a of Dantzick, at the late meeting in Ham- few minutes past ten he expired. The next burgh, appearing sufficient of themselves to of our friends who fell a victim to the choconvince ’the most sceptical. Yet it is not lera, was Mrs. L—. She was seized that the occurrence of resinous about nine o’clock on Saturday evening, and substances like the foregoing, whose origin died in about twenty-four hours. Her hus. is incontrovertibly mineral, should be suf- band, Mr. L- (Serepta commissioner), ficient to lend plausibility to the opinion, died in the course of three or four days after, on his that amber is of mineral origin also." way to Serepta Colony, to which he We believe the generic term of bitumen was conducting his three motherless cliil. would be more appropriate to this substance dren ; his death took place on the side of the than that of resin, inasmuch as one essential public road, three stages from Astrachan. character of the latter class of compounds, On Monday morning Mr. J. S., who is now viz. solubility in alcohol, is here absent. recovered, was reported to us as having been seized. I instantly called down, and was happy to find that having been bled with success, and taken other precautions, his DREADFUL RAVAGES OF THE CHOLERA situation was not peculiarly alarming. About MORBUS IN ASTRACHAN. mid-day the governor’s son was seized with THOUGH the cholera had made its appear- it, and expired before the close of day. The ance at the mouth of the Volga about six death of the governor’s son on Monday was weeks ago, it was not till Friday the 30th followed by that of the governor himself of July, that its beingactually in the city was the same disease on Saturday. ascertained. No sooner was this made Having thus given you a sketch of the liroknown to the public authorities, than a gress of the cholera in the circle of our En. council was summoned to make the neces- glish and German friends, &c., in their indi. sary arrangements for giving all possible vidual or family capacities, permit me to medical aid, and directions to such as might bring the scene before you as a whole, be seized with it. Papers were instantly which the progress of the cholera preprinted and circulated, with a statement of sented to our view. In general, business of the precautions to be taken for avoiding the every kind was at a stand; the bank susdistemper, and a sketch of the means of cure pended its operations ; in the bazaar not a to be employed in the first instance, till whisper was to be heard, and scarcelr a medical assistance could be procured, with face to be seen ; even the cabacks (tippling a list of the names and places of residence houses) were abandoned, and a general of all the physicians in town : and that no gloom was spread over the countenances of delay might be occasioned among the poor the few solitary individuals that were to be who had not servants at command, the senti- seen walking through the streets. Thsis nels, who are stationed night and’day in all gloom was heightened by their attituceture.
calling,
surprising
781
moving pensively along with handkerchiefs at their noses, perfumed with or containing
ON THE ASSOCIATION OF MEDICAL PRACTI-
TIONERS AT NEWCASTLE, AND THE ESTAinfection with BLISHMENT OF SCALES OF MEDICAL FEES. which, it was supposed by medical gentlemen, the air was in a manner saturated. According to the best’accounts, when the To the Editor of THE LANCET. disease was at its height, the number of on was and one particular day SIR,—When I invoked the assistance (f funerals 500, More than a thousand your pen in support of the objects of the on another day 480. were buried about that time in a large sand- Association of General Practitioners estabin this place, you will readily believe pit for want of graves, which could not be lished got dug so fast as required, nor at a rate that t anticipated not your opposition instead that the poor could afford to pay for them, of your support; that I little expected you twenty-five rubles being demanded for each. to designate the principle of our proceedings Such a time we have never seen, nor do I unsound, and to impute to us the very es. suppose that such a time was ever before sence of monopoly. I have to thank you, On the roads leading to however, for the readiness with which you seen in Astrachan. the burial-grounds which are out of the city have given a place in your Journal to the I sent you ; and though I scarcely any-thing was to be seen from with some coufidence, that on the morning to night but funeral processions. generally it will make a very difDuring its progress more than sixty officers, from the governor of the city, the com- ferent impression from that expressed by mander of the fleet, &c. downwards, fell yourself, yet knowing as 1 do the influence victims to it, and the number of the dead of of your opinions on many of its members, all descriptions in the city alone (the resi- I feel myself called upon to endeavour, dent population of which is not more than either to alter your view of the subject by 40,000), is calculated at about 6000 indivi- farther explanation, or to neutralise the duals, besides 1000, or, according to some, effect it is calculated to produce in preventnearly 2000 of those from the interior of ing the adoption of the course recommended Russia, that were passing the summer here, by other practitioners throughout the kingand fled to the towns and villages up the dom. It does appear to me strange to acVolga, in the hopes of escaping it. Of these, cuse the Association of monopoly, when, by above forty were found lying on the road one of its fundamental laws, every legal side unburied ou the first three stages, till practitioner is not only admissible, but is notice was-given of the circumstance to the actually invited to become a member; and commanding officer of the district. But the surely you would not recommend us to ingreater part of the fugitives who fell victims vite the St. John Longs of the neighbourto it, met their fate on the Volga. Nearly hood to join our fraternity. Where then is 10,000, it is said, left the city in great con- the monopoly ? It is as extended as the fusion, and being ill-provided with food and numbers of practitioners at least (and they other necessaries, were reduced to such in- are certainly not a few), and I am at a loss describable hardships on their passage up to know how its basis can be more extensive the river, that Calmucks, on its banks, or more liberal ; it is neither our wish to would have no intercourse with them. It is limit the existing’ number of practitioners said that one or more of the crews of these nor to prevent their increase. On the score boats perished entirely from the cholera, of monopoly then I am able to see no want and having none left to man them, were at of soundness in the prnieiplf. But you say, last carried down the stream with the resi- ’° It is further unsound, in its being an endue of the dead on board, and that in other deavour to estimate the value of mental From the acquirement and skill by the gross inefficient cases the ravages were dreadful. above statements it would seem that a sixth test of a metallic standard." Base, indeed, or seventh part of the population of Astra- would be the attempt (mulerialist as I may chau, chiefly adults, have been cut of by the be) to bring the intellectual exertions of a cholera ; and it is supposed that the one high and noble mind into comparison with half of the adults have been more or less the glittering dross which is too frequently affected by it. Some children that were the effective stimulus to human efforts, and seized with it died ; but the proportion of which has unfortunately become the medium these in comparison of adults was small. of compensation for all human services. It Mr. J. S-’s youngest child died of it, is indeed a subject of deep regret that it after been abandoned by its nurse. should be so ; and of yet deeper regret that The cholera is now as far up the Volga asI medical practitioners, however exalted may Saratoff, and as far west as Kieb.—Abridged be their principles of action-however generous and philanthropic, and disinterested from tlte Scot.111is. and Phil. Register. their desire to save life and to relieve suffering—that those humane and enlightened
camplior,
to couuteract the
communication
hope,
profession
having