being touched, and appeared partially broken up. Large particles of the acetate of zinc had collected on the surface of the polypus.

19th.-Polypus smaller; no discharge; has had a good deal of ear-ache. To syringe with warm water, and omit the use of the drops.

22d.—The pain is gone; there is no discharge; the polypus has wholly disappeared. The membrana tympani is now seen; its upper and posterior part is white and thick; at its anterior part, there are two small apertures, through which the mucous membrane of the tympanum is seen to be red and thick; the hearing has improved: the watch is now heard by the right ear at a distance of three inches; by the left, at a distance of two inches. Subsequent reports from this patient state that the discharge has not returned, and that the hearing continues to improve.

CHAPTER VII.

THE EXTERNAL MEATUS (concluded).

TUMORS.

OSSEOUS

TUMORS-STRUCTURE-TWO

CLASSES-TREATMENT-CASES-MOLLUSCOUS

TUMORS STRUCTURE-EFFECTS ON THE BONE-TREATMENT-CASE-CONCLUSION OF THE SUBJECT OF THE DISEASES OF THE EXTERNAL MEATUS-TABULAR VIEW OF THE MORBID CONDITIONS FOUND IN THE MEATUS EXTERNUS IN 1013 DISSECTIONS.

I. OSSEOUS TUMORS.

HOWEVER little it may have hitherto attracted the attention of the profession, there is reason to suppose that the growth of osseous

FIG. 37.

Two Osseous Tumors projecting from the anterior and posterior walls of the Meatus Externus, leaving a small triangular aperture below.

tumors in the external meatus of the ear is a disease of no unfrequent occurrence. Such tumors appear to be the result of a rheu

matic or gouty diathesis, and may be developed in any portion of the length of the tube; but the part from which they most commonly originate is about the middle third of the passage. In one case, however, the tumor extended beyond the outer orifice of the osseous meatus, and could be felt by placing the little finger at the meatus. Occasionally the posterior wall affords the point of origin. to the tumor, and then it not unfrequently resembles a simple bulging of the wall. In other cases, a similar tumor is also developed from the anterior part, and the two protuberances meet and lie in contact in the middle, leaving an inferior and superior triangular space in the place of the original opening of the tube. Sometimes the external surfaces of the tumors are in contact for nearly the entire length; and the only passage is a small orifice below. The tumor may also grow from the upper surface of the tube, and, by gradually increasing in size, almost or quite fill up the passage. Two or more tumors, again, extend sometimes from various parts of the circumference of the meatus, and, converging towards the centre, fill up nearly the whole cavity.

As far as my opportunities have permitted examination, these tumors, as in the one delineated below, appear to consist of ex

tremely hard and dense bone. In one case, where a portion of bone was denuded of membrane, it appeared shiny, white, and polished, like ivory. In another, where, under the misapprehension of the body being a polypus, caustic had been applied, the bone was exposed, and found to be extremely hard and devoid of sensibility. In a third instance, where I observed the membrane to be absent,

there was a thin layer of cartilage on the surface, beneath which the bone was very hard.

The tumors are usually covered by the lining membrane of the meatus, which is frequently thick, spongy, and less sensitive than is natural. When, by irritation, chronic inflammation is set up, this membrane pours forth a discharge whose odor is most offensive.

The development of these tumors is frequently unattended with any symptoms calculated to attract the attention of the patient; and therefore it is only when by their increase of size they act as an impediment to the passage of the sonorous vibrations to the membrana tympani, that the patient is inconvenienced by the deafness, and seeks relief. Deafness may result in these cases, first, from a collection of cerumen or epithelium lodging in and blocking up the small passage of the tube left unoccupied by the tumors; secondly, a drop of water may have entered the ear during the ordinary ablutions, and produced the same effect; thirdly, the growth of the tumor may have proceeded unchecked till the entire cavity of the meatus is filled up. In some cases, however, the growth of the tumors produces a feeling of distention in the ear, and weight in the affected side of the head; while in others, again, they appear symptomatic of, and consequent on, exostosis forming in the deeper regions of the ears; as, for instance, in the tympanic or vestibular cavities,—a condition I have sometimes detected in the course of my dissections. In three instances, subsequently cited, there seemed great probability of this being the case; and the distressing noises and sense of giddiness may probably have depended upon the pressure exerted on the expansion of the auditory nerve by an exostosis in the vestibule.

The only diseased substance with which the tumors are likely to be confounded, are polypi; from which, however, by very slight attention, they may readily be discriminated. When inspected by means of the speculum, the polypus is seen to be darker in color, and glistening, from being generally lubricated by discharge; the osseous tumor, on the other hand, is white; and though smooth, free from moisture. The base of the polypus is also generally narrow, while that of the osseous tumor is broad. Any doubt, however, is easily removed by the use of the probe, which being pressed against the bony protuberance, at once reveals its nature.

The disease under consideration may be divided into two classes. The first and most common is that in which the disease appears

associated with congestion of the mucous membrane of the ear. Most of the patients who have consulted me on account of it were in the habit of partaking freely of stimulating food and beverages. The second class showed symptoms indicative of disease in the cavities containing the expansion of the auditory nerve.

I will now proceed to point out some of the modes of treatment. In those cases where the tumors occupy a considerable space in the tube, and the deafness depends upon the occlusion of the canal by the accumulation of cerumen or epithelium, it is important at once to remove it, and prevent future accumulations. Where water penetrates into the orifice of the meatus, and fills up the only remaining pervious portion of the tube, wool should be placed in the orifice of the meatus when the patient is washing. Should the membrane covering the tumor, as is not infrequent, be very thick, a certain degree of relief may be afforded by the application of remedies which shall reduce its substance. In one case of this kind I was enabled to increase the size of the tube, and much improve the power of hearing, by applying a solution of nitrate of silver.

In order to diminish the size of the tumor itself, after the avoidance of a stimulating diet, the best remedy is that usually employed by surgeons in osseous growths, viz., iodine. This medicine I have prescribed internally, and have applied it behind the ear, and also to the surface of the tumors, with great advantage. In some cases large tumors were so much reduced as to allow of the passage of sonorous vibrations; and the patients regained in a measure that power of hearing of which they had for many months been deprived.

If further experience should establish the fact that these tumors can be arrested in their progress, especially at that early period when the area of the tube is but slightly encroached upon, much good may be accomplished and much suffering prevented or relieved. And while there are many weighty objections to any attempt to remove these tumors by operation or by escharotics, there are none to the use of iodine and the other absorbent medicines, from which there is every prospect, by persevering use, of successful results.

In consulting authorities on this interesting subject, the only observations I have met with in Kramer are the following:

"They (polypi) are even of cartilaginous and bony hardness. "A stalactite-shaped growth hung from the superior surface of the meatus, very near the membrana tympani, and was of so remark