ten days.

It is true that many persons live long, having had, during the whole of life, a discharge from the ear without any disease of the bone others live many years with a discharge, but at death the bone and dura mater are found affected, and might under many circumstances have assumed an active form of disease, ending in death. It is important, therefore, to be able to form an opinion respecting cases of the kind. To do this, it is first necessary to decide upon the source of the discharge. If it arises from the dermoid meatus, the membrana tympani being entire, there is, as before stated, most probably irritation in the tympanic cavity or mastoid cells, of which irritation the discharge is the symptom. Unless there were simply some eczematous state of the meatus to account for the discharge, and unless the hearing power were perfect, such a case should be looked upon with suspicion, especially if attended with any symptoms of brain or cerebral irritation. Again, if the discharge issues from the tympanic cavity through a small or a valvular opening, and it is requisite to blow the nose forcibly to clear out the tympanum, there probably is, or will be, some affection of the bone, from the accumulation of the discharge. If there is a large orifice in the membrana tympani, or that membrane is absent; if there is no ulceration of the mucous membrane of the tympanum; if there is some power of hearing remaining; and if by pressing and tapping the region round the ear, no pain is felt; and if there are no other symptoms of disease in the ear or head, I think it may be assumed that there is no disease of the bone; and that by attention to daily syringing, and the other plans alluded to when speaking of the treatment of these affections of the ear, there is a fair prospect of the disease remaining confined to the mucous membrane of the ear. On the other hand, it becomes a duty to state that any negligence on the part of the patient, by which the discharge should be allowed to collect so as to fill up the orifice in the membrana tympani-a blow on the ear, an attack of fever, or any severe illness, might cause an irritation in the ear, which, if unattended to, might advance to the bone.

CHAPTER XV.

THE DISEASES OF THE NERVOUS APPARATUS OF THE EAR, PRODUCING WHAT IS USUALLY CALLED "NERVOUS DEAFNESS."

a. DISEASES IN WHICH THE EAR ALONE IS AFFECTED:-1. FROM CONCUSSION-THREE MODES-BLOWS ON THE EAR-LOUD SOUNDS-FALLS. 2. FROM THE APPLICATION OF COLD-COLD AIR-COLD WATER. 3. FROM THE EFFECT OF MORBID POISONS-RHEUMATIC FEVER-TYPHUS FEVER-SCARLET FEVER-MUMPS-GOUT. b. DISEASES IN WHICH THE BRAIN AS WELL AS THE EAR IS AFFECTED:-1. MENTAL EXCITEMENT 2. BODILY DEBILITY-WANT OF SLEEP-ACCOUCHEMENTS

-OVER-STUDY-SORROW.

OVER-EXHAUSTION IN HOT CLIMATES-FASTING-NEURALGIA.

THE nervous apparatus which receives the sonorous undulations from the tympanum, and conveys them to the brain-one of the most delicate structures in the human body-is liable to many functional and organic derangements. As some cases of deafness dependent upon the derangement of the nervous apparatus connected with the organ of hearing, appear to be caused by the condition of the brain generally, or of that part in intimate relation with the acoustic nerve, it has seemed desirable to divide the nervous diseases of the ear into two classes: to the first of which belong those cases where the special nervous apparatus of the organ is alone affected; to the second, those where the brain conjointly with the ear, seems to be injured.

The first class may be subdivided into diseases arising from— (1.) Concussion.

(2.) The application of cold:

(3.) Various poisons: as that of typhus, scarlet, or rheumatic fevers, of measles and mumps, of gout, of an accumulation of bile in the blood, and of quinine in large doses.

And the second into diseases arising from

1 As I have nothing to add to the descriptions usually given of the anatomy of the labyrinth, I have not entered upon the subject.

(1.) Excess of mental excitement.

(2.) Physical debility.

(a.) DISEASES IN WHICH THE EAR ALONE IS AFFected.

This section will be occupied with a review of the various kinds of disease comprehended under the first of the above classes, all of which are usually accompanied by more or less of congestion."

(1.) Debility of the Nervous Apparatus of the Ear produced by Concussion.

Concussion may arise in three ways; either from a blow on the ear, or from the effect of loud sounds, or from a jar of the whole frame. Affections of the nervous apparatus of the ear, as the result of blows on the external organs, are not very common, since, as a general rule, the membrana tympani gives way and is ruptured, and consequently the shock on the drum is so far modified in its effect on the ossicles and the fenestra ovalis, that the contents of the labyrinth receive no greater injury than that which causes a slight dulness of hearing for a few days.

Cases of more permanent injury to the acoustic nervous apparatus do, however, sometimes happen from the effects of a blow on the ear, as in the following case.

Injury to the nervous apparatus of the ear, produced by a blow on that organ. A physician in London, while playing with his little children, suddenly brought his right ear in contact with the head of one of them, causing a rather severe concussion on that side of his own head. The concussion was instantly followed by a singing in the ears. I saw the patient soon after the accident, but could detect no unnatural appearance in the membrana tympani; and on carefully testing the hearing power by the watch, there appeared to be no dulness of hearing. This physician has been seen by me from time to time since the accident, and he tells me the singing remains as it was on the day the concussion took place.

The nervous apparatus of the ear is frequently injured also from the effect of a general concussion of the body, in which case the hearing power is often entirely destroyed. The well known in

stance of the late Dr. Kitto, who was rendered wholly deaf by a fall from the top of a house when a boy, may be noticed in illustration, and some others follow which have fallen under my own obser

vation.

Fatal deafness in the right ear, and partial deafness in the left, following a fall from a horse.-The Rev. R. F., aged 53. During many years his hearing has been dull during a cold. Five years before seeing me, he had a fall from his horse, and the fall was followed by a discharge of blood from the right ear for the space of two days, and subsequently of matter. For some days after the accident, the air whistled out of his right ear whenever the nose was blown. Since the accident, the right ear has been entirely useless, and the left so deaf that he has to be loudly addressed within a yard of that ear. There has also remained a constant singing noise in the head. On inspection, the hearing of the right ear was found to have been wholly destroyed, and the membrana tympani presented an orifice, the margins of which were opaque and uneven. Left ear. The membrana tympani was dull on its surface, and in parts calcareous.

In some instances, slight amelioration of the deafness following the accident takes place, as in the next case.

Total deafness in the right ear following a fall from a phaeton; gradual improvement.-The Rev. J. L., aged 35, had a deafness in the right ear during a cold four years ago. In the same year he fell from a phaeton, and was unconscious for some days. When he recovered his sensibility, he found that there was a hissing sound, like that from a teakettle, in the right ear, which was completely deaf. During two years, however, subsequent to the accident, the power of hearing gradually improved, so that the patient is able to hear a loud voice with that ear. The noises still continue, and are aggravated by wine, or by bodily or mental fatigue; when writing or studying, these noises become overpowering, but in the morning are much lessened. On inspecting the right ear, the air is distinctly heard by me to enter the tympanic cavity, but the patient experiences no sensation in the ear when it enters. A loud ticking watch is heard. When spoken to through a trumpet, loudly and slowly, the voice is heard, but not till a second or two after the word has been uttered. The membrana tympani was opaque.

The violent shock communicated to the nervous system of the ear (most probably through the medium of the membrana fenestræ ro