Tumors. The lobule of the external ear is subject to hypertrophy, and to the development of tumors in its substance. Tumors are also developed from the surface of the cartilage, or from the cellular tissue covering it.

Mr. Wilde relates a case of tumor in the substance of the lobule. "M. S., a female, aged 19,has a hard, firm, ovoid tumor occupying the centre of the lobe on each side, but largest on the left. It is of a stony hardness, and is quite distinct both from the cartilage above and the fleshy part of the lobe, which it appears to pass through. The skin covering it is smooth, and of a light pinkish hue, like that of a keloid tumor. It grew gradually from the orifice made for holding the ear-ring, and has been several months attaining its present size. The tumor upon the opposite side, which also surrounds the hole made for the ear-ring is much paler in color, and not larger than a garden pea. The girl states she experienced a great deal of pain and soreness in the wounds made in piercing the ears, and that about three or four months afterwards, she was obliged to remove the ear-rings, on account of the irritation they produced. The large tumor was dissected out, and the elliptical aperture left in the lobe brought together with sutures. It healed kindly, and the disease did not return. A section of the

tumor exhibited a dense yellowish-white fibrous appearance, and was so hard that the nail made no impression upon it."

Gouty deposits are not unfrequent in the external ear.

Scirrhus.-Kramer, in his work on the Diseases of the Ear, devotes a section to the consideration of a disease which he entitles "scirrhous degeneration of the auricle." In its early stages, he describes its symptoms as analogous to those of erysipelas. As the disease advances, excoriation and ulceration of the auricle takes place, and the cartilage is perforated and destroyed. The auricle becomes nodulated and misshapen; the nodules ulcerate. I have not met with the disease unless when complicated with disease of the petrous bone. Dr. Kramer cites three cases of supposed scirrhous degeneration: of these the following occurred in the practice of Dr. Fischer-A countryman, when eight years of age, perceived an itching, which depended on a scabby eruption of the head. This extended to the right ear, and its irritation being increased by roughly rubbing it with the hand, the skin was corroded. A redness and swelling of the ear, the certain attendants of inflammation, continued from that time, much encouraged by the plethora and strength of the individual. The disease now remained stationary for some years, but at the time of manhood it broke out afresh, and with increased intensity. During his twentieth year, it had acquired so enormous an extent that the whole auricle was converted into a knotty, deformed, and lumpy mass, in which the natural projection could scarcely be detected. At the anterior and inferior extremity of the antihelix the degenerate mass had begun to suppurate. Dr. Fischer cut away with a knife the whole degenerated ear, and the wound healed in less than six weeks.

THE external auditory meatus is a tube formed partly of cartilage and partly of bone. It extends in a transverse direction from the concha of the outer ear to the membrana tympani internally. Its length varies in the adult from an inch and a quarter to an inch and a half.

The Osseous Meatus.-There is a convexity about the middle of the lower wall of the osseous meatus which causes a slight central contraction of the calibre of the tube; and this convexity, combined with a similar one in the anterior wall, often prevents the anterior and inferior fourth or fifth of the membrana tympani being visible

A vertical section of the left Meatus Externus, from without inwards.

to the surgeon during his exploration. The superior and posterior walls are slightly concave: the anterior wall and floor of the meatus extend three or four lines further inwards; and as the membrana

tympani is attached to the inner extremity of each wall, hence the oblique position of this membrane. The upper wall has intimate relations with the cerebral cavity; the posterior is separated by a thin lamina of bone only from the mastoid cells; the anterior wall forms part of the glenoid cavity and the fossa parotidea. The outer orifice of the osseous meatus is of an oval shape, its longer axis being from above downwards, and slightly backwards. The anterior and inferior parts of the orifice are rough and scabrous, the fibro-cartilage of the meatus being firmly inserted into them. The posterior and superior parts of the orifice are smooth, and perforated by numerous orifices for the transmission of vessels. The inner orifice of the meatus is round, and in the groove of its margin the circumference of the membrana tympani is inserted.

The diameter of the external meatus varies much. In some adults, it is so large as to admit the introduction into it of the end of the little finger for a considerable distance, and the membrana tympani may be seen by means of the ordinary daylight, without the lobe being drawn back. In other persons, the meatus is so small as scarcely to admit a common goose-quill. The large size of the meatus depends generally upon the original conformation of the bony tube, but its contracted state is often the result of osseous development, or a thickened condition of the dermis, or the presence of bony tumors. The membranous meatus consists of the following laminæ, beginning internally:-1st, the epidermis; 2d, the dermis; 3d, the periosteum. Between the dermis and the periosteum of the outer portion of the tube are placed fibro-cartilage, cellular tissue, and ceruminous glands. The epidermis forms a cul-de-sac, which covers the whole of the outer surface of the dermis, and is prolonged over the outer surface of the membrana tympani, of which it forms the outermost lamina. In the outer part of the tube the epidermis is thick, and is perforated by the ducts of the ceruminous glands. Near to the outlet, it presents orifices for the passage of the hairs which frequently protect the entrance of the meatus. At the inner half of the tube, the epidermis is extremely thin, with a shining surface. The scales which compose the epidermis are constantly thrown off from the free surface of the membrane: they mix with the cerumen, and in the healthy ear are excreted with it.

The dermis also forms a cul-de-sac by being continuous with the dermoid layer of the membrana tympani. Near to the orifice of the meatus, the dermis differs but little from that covering the cartilage

of the concha, with the exception that it gives insertion, particularly in elderly persons, to numerous short strong hairs. More internally, the dermis is remarkable for its extreme sensibility, and gives passage to the ducts of the ceruminous glands. The outer half of the dermis is firmly connected, anteriorly and inferiorly, to the fibrocartilage; posteriorly and superiorly, where there is no fibro-cartilage; the dermis is connected to the superior and posterior parts of the osseous meatus by loose cellular tissue, in which the ceruminous glands are placed. At the inner half of the tube, the dermis is intimately connected with the periosteum, the two membranes being frequently inseparable.

The outer half of the membranous meatus contains, in addition to the lamina previously noticed, fibro-cartilage, which is continuous. externally with that forming the external ear, and, internally, is attached to the rough margin of the osseous meatus by fibrous tissue, which admits of considerable motion taking place between the cartilage and the bone. The outer part of the fibro-cartilage of the meatus projects and forms the tragus. The fibro-cartilaginous meatus

does not form a complete tube, being deficient at its posterior and superior third, where the blood vessels of the bone freely communicate with those of the meatus. The shape of the orifice of the meatus, consisting of fibro-cartilage, is more oval than that of the osseous meatus, and is composed, anteriorly and inferiorly, of the fibro-cartilage, covered by the dermis, posteriorly of the anterior border of the