otoscope, it is found that the Eustachian tube is impervious on the right side, and the entrance of air to the tympanum is but faintly heard on the left.

There is a white patch of ossific deposit on the right membrana tympani; it occupies nearly the whole of the upper half of the membrane; touched with the probe, it is rough, and unyielding, but although the end of the instrument was applied to it in a very careful manner, the patient experienced a painful sensation from its application.

This gentleman has had several attacks of gout, in connection with which the affection of the membrana tympani requires to be considered.

The deafness is much the same in degree on both sides, although the left membrana tympani does not display any remarkable feature of morbid change, if we except a state of opacity, seen at its circumference ; this gives an opaque rim to the membrane-a sort of arcus senilis of the ear. Viewing the morbid conditions already alluded to in connection with the age and constitution of the patient, we see good reason for supposing that other important changes may have taken place in the organ of hearing, but which are out of the reach of physical diagnosis, and the nature,

or extent, of which cannot be satisfactorily unveiled by any other mode of inquiry.

The results obtained by the employment of the tuning-fork tend to show that the true seat of hearing is less affected than the accessory or tympanic part of the auditory apparatus. The prognosis is evidently of an unfavourable kind, inasmuch as the morbid condition of the membrana tympani is more likely to be increased by the influence of the gouty diathesis, than lessened by the action of remedies.

It was thought well not to recommend the adoption of any surgical treatment, lest by irritation, which catheterism of the Eustachian tube might possibly produce, in a sensitive and irritable patient, some addition might be made to the morbid state already prevailing. Perforation of the membrana tympani did not appear to be indicated.

Opacity of the Membrana Tympani. Stomach affection.

Deafness.

Mr. H., æt. 52, has lately become deaf on the right side, where the membrana tympani is found to be opaque; the patient formerly enjoyed very good

health, but, during the last two years, has been troubled with dyspeptic symptoms, attended by frequent attacks of a very troublesome urticaria, so that the question is suggested, as to whether or no this affection of the membrana tympani has commenced in its lining, or mucous membrane, by virtue of those conditions of sympathy which tell so often on parts of the mucous membranes widely separated from each other.

Deaf people often complain of being more deaf when the stomach is out of order; and those who suffer from impaired vision not unfrequently see worse than usual from the same cause; but the stomach regaining its normal condition, hearing or vision improves; if, however, the gastric derangement be often repeated, and this for years, and if, at the same time, we have morbid alterations of the cutaneous surface, it is readily supposed that the lining of the tympanum may sympathise with such a state, as the lining of the nose is known to do with the gastric derangements of children; and it may be added, that continued disturbance of the nervous system of a part so finely organised as the tympanum may help the occurrence of organic change in a delicate texture like that of the membrana tympani.

It should also be borne in mind that deafness, in such a case, may not depend altogether on the morbid state of the membrana tympani; it may be produced, in part, by that disturbance in the nervous system of the ear which is supposed, in some measure, at least, to precede the occurrence of any visible organic change; of such an occurrence we have an analogue, as far as the eye is concerned, in those alterations of the pupil chiefly seen in its wide dilatation, which are not unfrequently met with in children suffering from worms in the intestines, and which seem to depend on changes in the sensibility of the retina, produced by the disturbed state of a distant part.

In this case, an emetic was recommended, to be followed by a few doses of blue pill, with gentian and Epsom salts; the nitrate of silver was rubbed upon the mastoid process, and a weak solution of it dropped once a day into the external meatus of the affected side; the results of this treatment have yet to be waited for.

It is worthy of notice that the cutaneous eruption above alluded to affected the right side of the face, more especially in the vicinity of the labial commissure, in an extreme degree, so that the lips, but more especially the upper, were now and then considerably swollen.

SECTION IV.

Otorrhoea.

THE nomenclature employed by nosologists is far from being perfect, while the inconveniences which would arise out of frequent alterations in the names of diseases are great enough to retard even desirable changes. The names applied to some diseases were given to them when the diseases themselves had been but little studied, and were very imperfectly known; and hence it happened that, in some cases, the name of a very obvious and characteristic symptom came to be adopted as the name of the disease itself, although it carried with it literally no idea or suggestion relating to the nature of the morbid changes which the parts most affected had undergone, or from which they were suffering; that such remarks apply to the word otorrhea requires no comment, and that they are equally applicable to the term deafness need not be mentioned.