On conservative aural surgery / by James Patterson Cassells.

  • Cassells, James Patterson, 1837-1884.
Date:
1876
Catalogue details

Licence: Public Domain Mark

Credit: On conservative aural surgery / by James Patterson Cassells. Source: Wellcome Collection.

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    diseases of the organ, as I have already said, but because the general experience of it will bear me out when I speak, by-and-by, about its frequency and destructiveness; and also for the further reasons, that the surgical treatment of this ear affection is that which is alone successful, and that aural surgery first appears as a con¬ servative art in connexion with its treatment. Let it not be sup¬ posed, however, for a moment that the principle of conservation in aural surgery is only applicable or visible in the treatment of this affection of the organ. In all the congestions of the tissues of the apparatus of hearing it is called for, and in none, for example, more urgently, than in those of the mastoid cells or external audi¬ tory meatus, out of which most of the serious and fatal conse¬ quences develop themselves—consequences nearly always avert¬ able, by the timeous incision of the congested tissue in the initial stage of the primary disease. Scarlatinal ear disease, the most destructive of all the ear diseases, and the one most frequently met with in general practice, arises out of the naso-pharyngeal affection, which is so marked a complication of this exanthem. The propagation of this conges¬ tion along the Eustachian canal into the cavity of the tympanum, and thence to the mastoid cells, must have been frequently wit¬ nessed, even by practitioners not specially interested in the practice of this department of our art. When this, the initial step in the causation of the ear disease, has taken place, its progress and de¬ velopment proceed with extraordinary rapidity. The Eustachian canal, as a result of this tumefaction of its tissues, becomes con¬ centrically closed; in consequence, there is a rapid increase in the congestion of the tympanic lining membrane, owing to the dis¬ turbance which a closed Eustachian tube causes in the balance of the tympanic air-pressure. Inspection of the membrana tympani at this stage shows it to be, in general, unaffected by the conges¬ tion of the tympanic lining membrane. The temperature of the patient at this period is considerably increased towards evening, without a corresponding fall in it in the morning; there is much restlessness, rolling of the head, and more or less delirium, gener¬ ally out of proportion to the violence of the general febrile attack. If now the interior of the ear be examined, the membrana tympani being still unaffected, except in a very slight degree, by the general congestion, it is generally possible to recognise through it the deeply purple-coloured tympanic lining membrane. As yet, there is no effusion into the cavity of the middle ear, although its outflow is imminent. Up to this point in the progress of the malady, it is possible by the timeous use of the knife to bring about resolution of the diseased action ; failing this favourable and more desirable termination, the certainty nevertheless remains, that by this means the disease is deprived of its power to commit damage. This stage in the treatment of the disease, I call that of resolution and prevention.