The diseases of the ear : their nature, diagnosis, and treatment / With a supplement by James Hinton.

  • Toynbee, Joseph, 1815-1866.
Date:
1868
Catalogue details

Licence: Public Domain Mark

Credit: The diseases of the ear : their nature, diagnosis, and treatment / With a supplement by James Hinton. 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.

    471/496 (page 445)
    Eustachian catheter might otherwise bo used, but my experience has led me to attach to the latter instrument great value both in diagnosis and in treatment. It happens sometimes, for instance, that even in cases in which nervous symptoms seem well marked, in which the membrana tympani looks healthy, and air forced into the tympanum by the patient enters with a natural sound, the introduction of air by the catheter is attended with wheezing and creaking sounds indicative of irregularity and narrowing of the Eustachian tube, and showing thus that a morbid condition of the mucous membrane has been present. In other cases the loud harsh rushing sound with which air enters the tympanum indicates at once a dry and unyielding condition of parts that should be supple. I cannot indeed affirm that any direct indications for treatment are derivable from the data thus obtainable by the catheter, or that great disappoint- ment would not result from methods of cure based simply upon them. But this does not deprive them of their value, at least as elements contributing to the future perfection of our knowledge, and as aids in unravelling the complicated connections of tym- panic disease with that of the labyrinth or deeper portions of the auditory apparatus. The following remarks on the treatment of closure of the Eustachean tube are from Mr. Toynbee's address on Benefi- cence in Disease: Supposing a case of this disease to be before us, and re- cognizing the fact that the deafness is caused by a closure of the Eustachian tube from thickened mucous membrane, and consequent absence of air from the tympanum, the first sugges- tion, of course, is to open the tube and to blow air into the tympanum. And this procedure, followed as it is by instan- taneous relief to the deafness (and by Politzer's operation with- out discomfort) is likely to be very popular. But supposing the deafness relieved by the injection of air into the tympanum, inasmuch as this air soon disappears, and the thick mucous membrane prevents the natural ingress of the air, of course the deafness soon recurs. A second suggestion then offers itself; it is to reduce the thickened mucous membrane by topical applications, and thus allow the tube to bo opened by