Practitioner's handbook of diseases of the ear and naso-pharynx / by H. Macnaughton-Jones.

  • Macnaughton-Jones, Henry, 1844-1918.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Practitioner's handbook of diseases of the ear and naso-pharynx / by H. Macnaughton-Jones. Source: Wellcome Collection.

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

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    tuning-fork placed on the head, he hears perhaps hadly, and the sound dies rapidly away. This can be ascertained by testing him as usual, and transferring the fork quickly to the observer's head or teeth, on the patient's making a signal that the sound has disappeared. It is possible he may not hear the tuning-fork at all when placed on the head, and we must transfer it to the teeth before the vibrations are conveyed. Closure of either ear pro- duces little difference {Hinton thinks slightly increases the sound); I am in- clined to think more frequently lessens it. We diagnose labyrinthine deafness of both ears. Such is, up to the present, the result of my experience in the majority of cases. On the disputed point of the patient hearing the sound less distinctly on closing the deaf ear (Roosa) in a case of uncomplicated nervine deafness, or its being slightly intensified (Hinton), after examining many hundreds of cases, I believe that the result is variable. Com- plications may exist which escape obser- vation, and may be oiitside our power of diagnosis. Such complications existing in the tympanum, and which involve its membrane and ossicles, would influence the result. That they coexist frequently with nervine deafness is, of course, true, and hence it may be the case that much of the difficulty lies in this source of error. Though the above rules as regard the diagnostic value of the tuning-fork are generally found to lead to a correct con- clusion, still anomalous cases are con- stantly occurring in a large aural practice, and in the instance of very intelligent persons, which I do not pretend to ac- count for, and which are more or less at variance with them. In these cases I am inclined to believe the mischief in such persons is not con- fined to the cavity of the tympanum and the ossicles, but probably from the effects of long-retained secretion, low inflamma- tory states of the lining membranes, adhesion, and partial anchylosis of the bones have been produced, implicating the labyrinth and nerve. In such patients we find the membrane unyield- ing on inflation, no improvement in suc- tion with the pneumatic speculum, and its concave and thickened appearance verifies the diagnosis. PAST TREATMENT. Before concluding the examination of any case, it is well to ascertain the nature of the treatment, if any, which has been previously adopted. This is particularly necessary in dealing with aural patients. In many instances it may be a guide to the prognosis that we give. It will also prevent the re- petition of the employment of useless remedies, and save the patient from interference, which cannot do good, and which may do harm. In a large number of cases various empirical means have been already used to com- bat the pain or deafness, and it is advisable, both for the confidence of the patient and as a guide to the surgeon, that all information on these matters should be elicited before the treatment of a case is commenced. It should not be necessary to give any caution as to the judicious care which must be shown in asking information on such points. The reputation, the welfare, at times the character of a brother practitioner are in our hands ; the man who, by look, word, or gesture, forgets the duty he owes that brother, through a base desire to advance his own interests at his expense, is un- worthy of the position he holds as mem- ber of our profession. Having now referred to the steps which it is necessary to take in making an ex- amination, and the several points to Fio. 36.—Nasal Speculum of Duplay. which we must direct our attention, I next proceed to notice the instruments useful in diagnosis and treatment.