PART I, (Part 1)

PART I, INTRODUCTORY SKETCH OF THE PROGRESS OF OTOLOGY. THE EXTERNAL EAR. INTRODUCTION CHAPTER I. A SKETCH OF THE PEOGEESS OP OTOLOGY. Theke is perhaps no department of the art and science of medicine in which there has been so much literature, with so little exact, or as we say, scientific knowledge, as that which was formerly known as aural medicine and surgery, but which is better designated by the term Otolog}\ 460-370 B.C.] Hundreds and perhaps thousands of volumes have been written on the anatomy, physiology, and diseases of the ear, from the time of Hippocrates until our own day, and yet until the age of Valsalva, the seventeenth century, the treatment of the affections of the organ of hear- ing was purely empirical, while the knowledge of its anatomy and physiology was often incorrect and fragmentary. Even after the investigations of the famous Italian, investigations which consumed sixteen years of his life, and the subsequent anatomical discoveries of the eighteenth century, it was re- served for our own day and generation to place the science of otology, or the knowledge of the anatomy, physiology, and diseases of the ear, on a level with that of other fields of labor in medicine. A singular apathy in regard to the maladies of one of the most important organs of the body, an inexplicable ignorance as to their results, a most irrational and empirical manner of treatment, have been our heritage from the fathers. Prob- ably to-day, in the closing years of the nineteenth century, there are more practitioners of medicine who view aural med- icine and surgery from the stand-point of the errorists of the 18 A SKETCH OF THE dark ages, than there are in any other field. It is to be feared that even now many wise and skillful men do not know, that to drop stimulating or even anodyne applications upon a membrane which they have never examined, to probe an ear for wax that they cannot see, are purely empirical practices which every conscientious physician should hold in ab- horrence. The great reformer of this science, Wilde* wrote, as late as 1853, that " the affections of the ear, whether func- tional or organic, are spoken of, lectured on, written of, and described (even in great part to the present day), not accord- ing to the laws of pathology which regulate other diseases, but by a single symptom, that of deafness." It is with no desire to recount the details of the long and painful story of the gropings in the dark, which have charac- terized the teachings on otology from the days of the philoso- pher of Cos, until the seventeenth century, that the author attempts an historical sketch of our progress up to our present position. He has neither the time nor the facilities for such a task ; but he has simply aimed to sketch the outline history of otology, from the sources to which he has been able to gain access, in such a manner as to show the obstacles which, until twenty years ago, have prevented the satisfactory progress of the science. The authorities which I have consulted in this introduction will be found at the close of the chapter ; but I must first of all make especial acknowledgment of my indebtedness for the greater part of my material to that valuable compendium, Linches Handbuch der Ohrenheilkunde. I have, however, consulted the original authorities as far as the best medical library of New York, that of the New York Hospital, and my own, would permit. Where no other authority is given in a foot-note, Lincke is the one from which I quote, and often by an exact translation. The discoveries and teachings in the anatomy of the ear will be first reviewed, after which the progress in the examin- ation and treatment of its diseases will be noted. * Aural Surgery, English edition, p. 7. PEOGEESS OF OTOLOGY. 19 PEOGEESS IN THE ANATOMY OF THE EAE. Hippocrates probably knew very little of the anatomy of the ear, although it is supposed on doubtful grounds 570 B.C.] that Alcmceon, a disciple of Pythagoras, was aware of the passage that led from the cavity of the tym- panum to the throat, inasmuch as Aristotle quotes him as saying that goats breathed through their ears. 384-322 B.C.] The knowledge of Aristotle as to the ana- tomy of the ear did not go beyond the mem- brana tympani. A.D. 98-117] Rvfus ofEphesus, who was the first medical lex- icographer, and who lived in the age of Pliny,* used the names helix, lobe, tragus, and anti-tragus, which are still employed to describe the different parts of the auricle. Marinus, the preceptor of Galen, and whom Galen named the restorer of anatomy, called the acoustic and facial nerve one, under the name of the fifth pah1. A.D. 130] Galen does not seem to have made any great advance in anatomical studies, and they were greatly neglected down to the fifteenth century. The darkness of the blind leading the blind is scarcely broken for thirteen hundred years. What Galen wrote was authority, and naught else. One valiant skeptic in medicine would have effected more good during these centuries, than all the ponderous tomes that were written by philosophers who reasoned upon premises that had never been thoroughly established. So late as 1559 one Doctor Geynes was called before the College of Physicians in London, for impugning the fallibility of Galen. On his ac- knowledgment of his error, however, he was again received into the college.t The strong arm of the church, in. the dark ages, prevented anatomical investigations on the human cadaver, and for hun- dreds of years anatomical knowledge remained at a stand-still. Galen, however, corrected the error of his preceptor in thinking that the facial and acoustic nerves were one, and showed that the latter entered the meatus auditorius interims, i * History of Medicine. Dunglison, p. 166. f Chambers' Encyclopedia. American edition. Article, Galenus or Galen. 20 A SKETCH OF THE a passage which his predecessors had regarded as impermea- ble. He gives no account of the anatomy of the internal ear, although he compares it to a labyrinth, a name which Fallo- pius, fourteen hundred years later, fastened on it forever. There is no record of the ossicula auditus until the fifteenth century. Two Italian anatomists, Achilini and Beren- 1480] gario, were the first to describe these bones, although they were not the discoverers of them. Berengario also first described the membrana tympani " with exactness." The exactness of his knowledge may be shown by the fact, that he was doubtful whether the origin of the membrane was from the acoustic nerve, or the meninges of the brain. 1542] Andreas Vesalius, who is said to have been the most accurate anatomist of his day,* described the long pro- cess of the malleus, the Eustachian tube, the vestibule, and the semicircular canals. 1604] The honor of the discovery of the stapes bone is claimed by no less than three anatomists, viz., Ingrassia, Columbo, and the renowned Bartolommeo Eustachius. The former wrote commentaries upon Galen's works, that were published long after his death. He claims to have shown it to his scholars in 1546, at Naples. 1523-1582] Gabriel Fallopius, of Modena, died in the bloom of youth, at the age of 39,t but he lived long enough to accomplish much for anatomical science. He showed, among other valuable points in the anatomy of the ear, that the mas- toid cells communicated with the cavity of the tj^mpanum. He described the fenestrse rotunda and ovalis, and gave his name to the canal in which runs the facial nerve in its passage through the cavity of the tympanum, acgumduct is Fallopii. The great Cuvier regarded Vesalius, Eustachius, and Fallo- pius as the three anatomists of the sixteenth century to whom belongs the honor of having restored the science of ana- tomy. 1500-1574] Bartolommeo EustacMus described the tensor tympani as well as the stapedius muscle. He * DungHson. History of Medicine, p. 233. \ Chambers' Encyclopedia. Article, Fallopius. PROGKESS OF OTOLOGY. 21 also gave a more exact account of the tube leading from the pharynx to the middle ear, which is called the Eustachian tube, although it was discovered by Vesalius. Eustachius also gave a superficial description of the cochlea. It is said that if poverty had not prevented Eustachius from publishing his anatomical plates, anatomy would have attained the perfection of the eighteenth century some two hundred years earlier.* 1587] The first monograph on the anatomy of the ear was from the pen of Volclier Koiter, a student of Fallopius. It contained no original observations, however. 1543-1573] Constant Varolius,f so well known from bis de- scriptions of the brain, made the singular mistake of supposing that the muscles of the cavity of the tympanum were nerves which were torn by the sawing through of the bone. Subsequently he admitted this error ; but he went so far to the other side as to say that the tensor and laxator tym- pani muscles could be moved at will. 1537-1619] LmckeJ does not think that the famous Fabri- cius of Acquapendente, contributed very much to our knowledge of the anatomy of the ear, while he led many away into error as to some points. For example, he thought that the chorda tympani nerve was a peculiar body, and not a nerve. At any rate, Fabricius did good service by his labors as a comparative anatomist, and it should be remem- bered that he was the instructor of the discoverer of the circu- lation of the blood. 1593-1609] Julius Casserius, who was a professor in Venice in 1609, a pupil and subsequently a rival of Fabri- cius, described the fissures that make the cartilaginous por- tion of the canal so flexible. He and Fabricius described the laxator tympani minor in the same year, and both claim to have discovered it first. Casserius also gave a better descrip- tion than had hitherto been done of the membrana tympani, the ossicula auditus, and the labyrinth. He was the first to * Chambers' Encyclopedia. Article, Eustachius. f Biographie Medicale. Paris, Pankoucki. X Handbuch, Bd. I., s. 14. 22 A SKETCH OF THE describe the three and a half turns of the cochlea and the membranous zone. 1665] The ceruminous glands, whose function and physio- logical action were first described by Nicolaus Stenon. Lincke speaks of him as Stenson ; but this must be a mistake in transcribing the name of the great Danish anatomist. Passing on to the seventeenth century we find Antonine Marie Valsalva rising up a head-and-shoulders above the ana- tomists of his age, and far exceeding his predecessors in the amount and exactness of his knowledge. He devoted more than sixteen years of his life to the study of the anatomy of the ear, and for the purpose of its study dissected more than a thousand heads. His master- work was a treatise on the ear.* This work passed through five edi- tions in a short time. He described the attachment of the tensor tympani to the Eustachian tube. He made the mis- take, however, of supposing that the ossicula auditus had no periosteum, and that the cavity of the tympanum was con- nected by many openings to the cavity of the cranium. He discovered the muscle that dilates the Eustachian tube and moves the uvula. He also showed that the fenestra ovalis was covered by membrane. His anatomical plates show a good knowledge of the cochlea and semicircular canals. Morgagni, himself an original investigator, a student and friend of Valsalva, edited his master's work and made some additions. Of Valsalva's contributions to the treatment of the ear, which were quite as important as his anatomical investiga- tions, we shall have occasion to speak in the second part of this sketch. 1714] Valsalva had a rival, whose name the lapse of time has well nigh effaced, Baymond Vieussens, who also wrote a work on the ear. He gave new names to various parts of the organ ; but his descriptions are said by Lincke to be so mysterious that his contemporaries could not under- stand them. 1717] Bivinus, professor in Leipsic, observed an opening * Tractatus de Aure Humana. Lugdunum Batavorum, 1742. PROGRESS OF OTOLOGY. 23 in the membrana tympani, which he believed to be a constant anatomical condition. This supposed discovery excited the warmest discussion among such anatomists as Walther, Muysch, Morgagni, Cassebohm, and Valsalva. Hyrtl, the present dis- tinguished anatomical teacher of Yienna, showed that it was a rent in a macerated membrane ; but his predecessor, Berres, believed in its existence and described it minutely.* Quite recently Professor Bochdalek, of Prague, has revived the question,t and has described the foramen of Kivinus as a constant opening in the membrana tympani ; this author says that there are sometimes two. It is, however, according to Bochdalek, so small as not to be seen without the aid of a magnifying glass. In a discussion in one of the medical societies of Vienna,:}: Professors von Patruban, Gruber, and Politzer, unite in affirming its existence, thus confirming Bochdalek's state- ment. 1718] The famous Ruyscli (Frederick), professor in Amster- dam, contributed to our knowledge of the distribution of the vessels of the cavity of the tympanum, and corrected Val- salva's statement that the ossicula were not covered by peri- osteum. 1730] Cassebohm (Joan. Frid.), published a monograph upon the ear, in six parts, which Lincke calls " a monument to the German industry and spirit of inquiry of the time." " Ein Denknial deutschen Fleisses und deutschen Beobach- tungsgeistes." He disproved Valsalva's idea of the close connection between the cavity of the tympanum and the cerebrum ; he •described the cochlea, and the development of the auditory apparatus in the foetus. 1747-1753] Brendel and Zinn, two Gottingen anatomists, the latter of whom is well known as the describer of the suspensory ligament of the lens, known as the zonula of Zinn, made further investigations as to the structure of the cochlea. 1 761 ] Dominic Cotugn o, or Cotunni, the discoverer of the fluid * Prager Viertel. Talirscbrift, 1866, I. f Troltsch on the Ear, 2d American edition, p. 26. \ Monatsschrift fur Okrenheilkunde, Jahxgang III., No. I. 24 A SKETCH OF THE of the labyrinth, won such a reputation by his work upon the internal ear, that he was called to the anatomical chair at Naples. He was the first clearly to show that the labyrinth was filled with fluid, and that this was one of the neces- sities for the perception of the undulations that we call sound. 1747-1832] Antonio Scarpa issued a work on the structure of the ear, which brought the knowledge of its inner arrangement to such a height that it seemed to his contem- poraries that there was little more to be done. The investi- gations of our own day have shown how premature was this expression. Scarpa wrote upon the fenestra rotunda, which connects the tympanic cavity with the lamina spiralis of the cochlea. He described the osseous labyrinth with exactness, the membranous labyrinth, and the expansion of the acoustic nerve. Scarpa was secretary to the octogenarian Morgagni, when the latter had lost his sight, and he wrote letters of advice in Latin at the dictation of his blind preceptor. 1797] Alexander Monro," " Professor of Anatomy, Medicine and Surgery," in the University of Edinburgh, was the author of a monograph on the organ of hearing in man and other animals. It is a fine specimen of typography. In his preface he states that Dr. Camper called in question his description of the semicircular canal in whales, and that Scarpa said that some of his teachings in regard to the human ear were erroneous. Professor Monro claims to have been the first anatomist to trace the auditory nerve within the cochlea, vestibule, and semicircular canals. He quotes from Valsalva, Winslow, Cassebohm, Haller, Cotunnius, Mec- kel, and others, to show that none of these anatomists had traced nerves into the cochlea. Dr. Monro seems to make out a good case for himself as against Scarpa, as far as I have been able to determine, and to be entitled to the credit of having traced the nerves into the cochlea before with greater minuteness than Scarpa, and appears to have been correct in his comparative anatomy. * Three treatises on the Brain, the Eye and the Ear. Edinburgh and London, 1797. PEOGEESS OF OTOLOGY. 25 1800] Mr. Everard Home wrote an excellent, and, for its time, exact account of the membrana tympani in a paper for the Boyal Society.* The measurements are accurately given, but Mr. Home supposed that the fibrous layer was muscular. He seems to have been a comparative anatomist of great ability. 1806] Samuel Thomas Soemmering, a great name in anatom- ical science, contributed to otology by a series of plates of the anatomy of the ear, which are almost as well worth study to-day as they were seventy years ago. 1832] Henry Jones Shrapnell contributed a series of papers to the London Medical Gazette, f He described the membrana flaccida of the drum-head, its nerves, with clear- ness and accuracy. His description of the former is available for the student of the present time, and Shrapnell's membrane is probably firmly fixed in the nomenclature of the anatomy of the ear. 1832] Thomas Buchanan, of Hull, brought out a monograph illustrative of the anatomy and diseases of the ear. His ideas as to the importance of the cerumen produced many errors in treatment, from which the profession has not yet fully recovered. He published four works ; the title of the last one illustrates what has just been said : " Physio- logical Illustrations of the Organ of Hearing, more particularly of the Secretion of Cerumen, and its effects in rendering Auditory Perception acute and accurate.''^ 1836-39] The distinguished English surgeon, T. Wharton Jones,