Volume 1

Glasgow hospital reports / edited for the committee by George S. Middleton [and others].

Date:
1898-1901
Catalogue details

Licence: In copyright

Credit: Glasgow hospital reports / edited for the committee by George S. Middleton [and others]. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    28/380 (page 12)
    conversant with the supervention of paralysis in consequence of inflammation of the tympanic cavity; but I know of no other case in which there was a combination of these two sets of symptoms. It will be useful, therefore, to inquire into the nature of the case. There can be no doubt that the shock produced by the report of the cannon caused an immediate injury to the ear, and one can have little hesitation, judging from what we know to be the usual cause of deafness from concussion, in affirming that some injury was done to the nervous apparatus in the internal ear; but, unfortunately, sufficient opportunity has not yet been afforded for ascertaining the exact form of injury which is produced in these cases. It is to be hoped, however, that, as the diseases of the ear come to be more carefully studied by the profession, this point may be satisfactorily elucidated. But in addition to the injury inflicted upon the internal ear, I have no doubt that a rupture of the drum took place at the moment of the discharge of the gun, for this is by no means a rare result of loud noises, and, besides, it would satisfactorily account for the very distinct cicatrix which was noted at the first visit of the patient on the posterior segment of the drum, and likewise for the subsequent symptoms. I have thus endeavoured to account for the sudden tinnitus and loss of hearing, and for the cicatricial appearance of the drum; but how can the paralysis be accounted for ? The explanation I give of it is this: The injury done to the drum and other structures in the middle ear excited a chronic inflammation of the mucous membrane of the cavity of the tympanum, unaccom- panied, as is so often the case, by any appreciable pain. Hence the opaque appearance of the drum when the patient first came under observation, and the partial obstruction of the tympanic orifice of the Eustachian tube. As this inflammatory condition proceeded it extended to the aqueduct of Fallopius, as we observe in many uncomplicated cases of tympanitis; and the portio dura nerve in this canal becoming implicated, paralysis of the right side of the face supervened. The object of the treatment was to allay the inflammatory •condition, and the result was as satisfactory as could have been -expected under the circumstances.