Politzer's text-book of the diseases of the ear and adjacent organs... / by Adam Politzer ; translated by Oscar Dodd ; edited by Sir William Dalby.

  • Politzer, Adam, 1835-1920.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Politzer's text-book of the diseases of the ear and adjacent organs... / by Adam Politzer ; translated by Oscar Dodd ; edited by Sir William Dalby. 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.

    698/760 (page 682)
    DETECTION OF SIMULATED DEAFNESS. frequent than that of unilateral or bilateral dulness of hearing. This is explained by the fact that the total deafness of an individual is generally known, and the truth concerning it more easily ascer- tained by inquiry than in the case of dulness of hearing, more especially when the latter affects only one ear. In really existing defects dulness of hearing is most frequently exaggerated. The method of testing for the detection of simulation must always be preceded by the examination of the membrana tympani and of the Eustachian tubes. If considerable changes are found, which indicate an affection of the middle ear, in such cases the principal requirement is to ascertain the degree of disturbance of hearing, as the capability or incapability of soldiers depend upon that. In the presence of inflammatory changes in the external and middle ears, it must be noted whether these are not artificially produced and maintained in order to escape military duty. According to Chimani, these affect almost exclusively the external meatus, less frequently the middle ear, and never the internal ear. Artificial inflammations of the external meatus and of the membrana tympani are usually caused by cauterization, and are distinguished from those spontaneous affections by the peculiar form of the disease as well as by its course, the artificial inflammations healing in a very short time, when aU further irritation has been rendered impossible by means of a bandage. Sometimes also foreign bodies are intentionally inserted into the external meatus, either to feign a disease of the ear, or, in cases of pretended dulness of hearing, to pass througli the testing process the more easily. The difficulty is greater in cases in which there are no objective indications of an affection of the middle ear, as then we are limited to the investigation of a circumscribed affection of the fenestras of the labyrinth or of the nerve, the diagnosis of which is often sur- rounded with great difficulties. A number of methods of examination have been proposed for the detection of simulated disturbances of hearing with negative con- ditions of the middle ear, and these will be briefly described. It must, however, be remarked at the outset that even although the premises are very excellent upon which several of the methods are based, only very few of them can stand the test of experience, especially when a cunningly-devised plan of dissimulation has to be overcome, as is so frequently the case. The procedure varies according as the dulness of hearing or deafness simulated is unilateral or bilateral. In cases in which a unilateral deafness is said to exist, it must first be ascertained whether the affected ear is quite deaf or capable of hearing to a certain degree. In the latter case, by closing the other ear and bandaging the eyes, the hearing-distance of the deaf ear must be measured by the acoumeter or by a loud clockwork, e.g., a metro-