A manual of diseases of the ear, for the use of students and practitioners of medicine / by Albert H. Buck.

  • Buck, Albert H. (Albert Henry), 1842-1922.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: A manual of diseases of the ear, for the use of students and practitioners of medicine / by Albert H. Buck. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    of the tympanum. By dissecting the edges carefully I was able to loosen it and remove it as a single tough, leathery mass. A considerable portion of the bony ridge situated just above the drum-membrane had been destroyed, and the larger part of the epithelial plug was located in the excavation which remained. The polypoid growths sprang from the outer margin of this same excavation. The relief which the removal of this tightly fitting mass afforded the patient was apparently very great. On the 27th of December the patient returned to the city and reported that she had carried out my instructions (simply to douche the ear daily with lukewarm water) faithfully, and that as a result the discharge had ceased entirely since the middle of the month. The pain and sense of discomfort in the head had also entirely disappeared. I examined the ear and found the parts perfectly clean and pale, with no signs at any point of a tendency to develop granulation-tissue. The preceding case may be taken as a fair type of these not very rare cases. If one can judge correctly from the published reports of many of the best authorities, the mastoid antrum is the most frequent starting-point of such desquamative processes.1 Marked variations from the type described above, however, are occasionally encountered. As an instance of such an exceptional course of the disease, I will narrate the following case: Case II.—The patient, a strong, healthy man, twenty-five years of age, had been subject to frequent earaches and to an occasional discharge from both ears since childhood. During the last three weeks of September, 1875, he had experienced constant pain in the left ear. When I examined his ear on the 1st of ()c- tober, 1875, I found the external auditory canal blocked up with a red, fleshy mass, which sprang from the upper wall of the canal. The most prominent portion, which looked like ordinary granu- lation-tissue, was removed with the snare, and then it was ascer- tained that the fleshy mass which blocked the entrance of the external auditory canal was really the prolapsed upper cutaneous wall, in which an opening had established itself. A probe intro- duced into this opening could readily be passed in to a distance of fully three-fifths of an inch, without encountering at any point denuded bone. Considerable cheesy and very foul pus was re- moved from the contracted meatus, but no view could be ob- tained of the deeper parts, owing to the fact that the prolapse of the upper cutaneous wall of the canal extended inward as far, apparently, as to the immediate vicinity of the membrana tyin- p.ini. As this prolapsed portion could not be lifted back to its natural position, it was evident that some substance (cheesy pus, .•is I supposed) had accumulated between it and the bony wall. For its removal I adapted a slender nozzle (diam. U mm.) to an ordinary hard-rubber ear-syringe, interposing between it and the nozzle of the syringe a short bit of rubber tubing. This slender nozzle was introduced without any difficulty into the month of the sinus, and upon forcing in the warm water it was found that i he greater part of it returned by the side of the nozzle, while the i Consult \'<>n Troeltsch (Arch. f. Ohr., IV., p. 105); Toynbee (Medico-chirurg, Trans., vol. xlv.); Lues (A. f. O.. VII., p. 255); Duncanson (Edinb. Med. Jour., Nov.. 1877); Matthewson (Trans. Amer. Otol. Soc., 1878); Moos (Archives of Ophthal. and otol., III., No. -'). and Kipp (Archives of Ophthal. and Otol.).