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a very remarkable and interesting case, showing the influence over typhus fever which is produced by cheerful impressions on the mind. When a youth he was educated in the country, in a very remote part of which he was in the habit of visiting, in company with a farmer's daughter, various scenes of beauty and sublimity, and, among others, the nest of an eagle in a romantic situation. For some time these visits were very frequent. Rush afterwards left the school, and settled in Philadelphia, where he found his former associate a married woman. Many years after she had an attack of typhus fever, under which she lay in a complete state of insensibility, apparently lost to all surrounding objects. In this state Rush, then a physician, was called to visit her. He took her by the hand, and said with a strong and cheerful voice, The eagle's nest!' The words revived an association of ideas comprehending the actions of her youth. She immediately grasped his hand, opened her eyes, and from that hour recovered rapidly." (P. 573.)
Our author says,
"I have known several individuals excessively dissipated among women, who have, by adopting certain precautions, avoided both chancre and gonorrhoea. They were extremely cleanly, and after indiscriminate intercourse they used soap and water twice or three times, and two or three clean towels. I know one individual who had been several times the subject of gonorrhoea and chancre, but who never had an attack after he adopted this plan, although he continued equally dissipated. I think it is almost a complete preventive." (P. 763.)
We have sometimes thought that this precaution must be of more efficacy in preventing chancre than gonorrhoea; or, in other words, that the prevention of the latter disease must require very industrious and vigorous washing indeed, if it arises from particles of virus lodged in the urethra. Still it is an admirable preventive. Diluted liquor potassæ, which is often recommended, has one advantage: it is medicinal, and therefore more likely to be adopted.
It is almost needless to give a formal recommendation of a work like this. Our numerous quotations carry their own panegyric with them. Mr. Rix has our hearty thanks for the zeal and ability which he has displayed in enriching medical literature with this excellent text-book.
Erfahrungen über die Erkenntniss, und Heilung der langwierigen Schwerhörigkeit. Von Dr. W. KRAMER.-Berlin, 1833. Practical Observations on the Knowledge and Cure of Chronic Deafness. By Dr. W. KRAMER.-Berlin, 1833. 8vo. pp. 106. In the review of Mr. Lawrence's work, in our first number, we ventured to assert that medicine has its debateable ground; that, in the empire of the healing art, as in some disorderly, half-civilized state, there are distant tracts over which the authority of the scientific practitioner seems scarcely established, and where the noisy charlatan (like the moss-trooper of old,) bears sway, in the absence of some more respectable functionary. Now, many judicious persons are disposed to think that all which concerns the art of curing the diseases of the auditory apparatus is at present in this unsatisfactory state, and they are apt to compare aurists to those "juggling fiends" of whom Macbeth speaks:
"That keep the word of promise to our EAR,
And break it to our hope."
The passage, indeed, from which we have quoted, seems especially designed for the reprehension of semi-medical writers, for they really "palter with us in a double sense:" while one eye is directed to the profession, the other, by a kind of authorial strabismus, is turned to the public; and their books, between these two sources of patronage, of course, fall to the ground. This strong and natural prepossession against 'ear-books must not, however, prevent our readers from listening to Dr. Kramer; for he is a sober and a candid practitioner, narrates his failures as well as his successful cases, and has produced a work worthy of the highest commendation.
In the introduction, Dr. Kramer observes that total blindness is not so great a misfortune as total deafness: he who is deprived of sight can associate freely with his fellowcreatures, and take part in the merriest conversation; while the deaf man distrustfully contracts more and more the circle of his acquaintances, suspiciously watches every motion of the lips of his best friends, and, retiring from cheerful society, in which he cannot participate, sinks deep into gloomy reveries. It might naturally be expected, therefore, that the pathology of the ear should have been studied with as much zeal as that of the eye. But this is far from being the case; for, while ophthalmological books are sufficiently numerous to form a considerable library, the list is short indeed of those writers who have studied diseases of the ear; and still shorter is the catalogue of those who have studied them with advantage.
Itard deserves the first place, for his work entitled “Traité sur les Maladies de l'Oreille et de l'Audition," which is a treasure of well-founded observations on the acute and chronic diseases of the organ of hearing; but the latter, unfortunately, have not been treated with so much attention as the former. "Far be it from me," says Dr. Kramer, "to wish by this remark to make the great merits of Itard appear less; but he is certainly in the wrong when he treats of tinnitus aurium as if it were an independent disease, though it is without exception merely a symptom accompanying the most varied forms of diseases of the ear, when at one time he divides chronic deafness into species, according to the causes which produce morbid changes in the organ of hearing, and at another time, according to these morbid changes themselves; and we must deeply lament that he passes over the treatment of chronic deafness so lightly, since its frequent occurrence, and obstinate continuance, demand the most attentive and circumspect treatment."
Next to Itard, Dr.Deleau deserves especial mention, though unfortunately he wastes his strength in little ephemeral essays, in order that his eagerness for distinction may be gratified by being continually before the public. In every page of his writings he cries up his own great merits, which, when accurately investigated, may be resolved into this one point, that, in treating diseases of the Eustachian tube, he has substituted the air-douche for watery injections; the advantage of which is not so preponderating as he would have us think. All the remaining writers, says our author, have advanced the study of these diseases but little, or not at all; they content themselves, for the most part, with repeating the errors and prejudices of their predecessors, not even noticing wellestablished truths: thus, for example in the writings of Curtis, Riedel, Beck, and others, we find no mention of Itard and his excellent work.
In treating chronic deafness, it is necessary to observe accurately the distance at which the patient can hear; for without this it is impossible to judge of the intensity of the disease, or of the value of the treatment pursued. This has been hitherto but little done, and hence the small value of the cases published. Perfect deafness is very rare, and is always incurable; it cannot be meant therefore, when we read, as we so often do, that the patient had lost his hearing. It is, of course, a matter of great interest to know to what degree the patient's hearing has suffered in each single case; and for this purpose Itard invented his acoumètre, (Traité, &c. vol. ii. p. 50,) an instrument to measure the distance at which a given
sound is heard. In the whole of his work, however, there is not a single instance in which he made use of this instrument; a circumstance which greatly weakens our opinion of its utility.
Dr. Kramer uses his watch for this purpose: its ticking can be heard by a healthy ear at the distance of twelve or fourteen ells, when all is still around. This is undoubtedly a very convenient instrument, and the only objection to its use consists in the immense variety of strength in the ticking of different watches: if the reader should happen, like ourselves, for example, to have a watch with Geneva works, he will find that none but Fine-ear himself could hear its ticking at the distance of twelve ells.
After describing the anatomy of the organ of hearing, Dr. Kramer gives his method of examining, or, as he terms it, catheterizing the Eustachian tube. He uses for this purpose a silver catheter, five inches and a half long, and varying from the thickness of a crow-quill to that of a goose-quill; it is straight, excepting for five lines near its point, where it is bent at an angle of 144°, in order to correspond with the entrance of the Eustachian tube. The catheter is of equal thickness throughout, excepting at the external extremity, where it is broader, in order to admit the pipe of an injection syringe. At this end of the catheter likewise a ring is soldered on, to shew by its situation the position of the point after it has been introduced into the nose. The Eustachian tube is examined in the following manner: The patient being placed on a chair, the operator sitting down before him, takes hold of the catheter immediately above its funnel-like expansion, keeping the concavity of the catheter downwards; and then, bringing the point into the lower nasal meatus, he pushes it quickly, but carefully, into the fauces. This manœuvre must be executed with a delicate and sure hand, partly in order to spare the patient pain, and partly in order to overcome with success all the difficulties which stand in the way of the catheter, from the lateral deviation of the septum narium, and from irregularity in the structure of the nasal muscles, difficulties which cannot be surmounted by rule.
The catheter being now introduced so far as to touch the posterior wall of the fauces, (till when the ring, and consequently the point, are directed downwards,) the handle must be raised, and the point will glide over the roundish prominence of the hamulus pterygoideus, and, touching the posterior wall of the velum palati, will compel the patient to swallow; while this takes place, the operator turns the ca
theter one quarter round its axis outwards and upwards, and it enters the Eustachian tube. It is now arrested by the cartilaginous ring at the entrance of the Eustachian tube; the most certain sign for an experienced hand that the catheter has been properly introduced. The ring of the instrument is now horizontal, or even a little turned upwards, and the patient experiences no pressure or inconvenience from this little operation. The process is much facilitated if the calibre of the catheter exactly corresponds with the nasal meatus of the patient, so as perfectly to fill it up. The catheter being now properly situated in the entrance of the Eustachian tube, the operator blows into it, either with his breath or with a small pair of bellows; the patient then feels the stream of air pressing against the membrana tympani, and attempting to force a passage outwards; a proof that the Eustachian tube and the cavity of the tympanum are free from any mechanical obstruction. But, if the patient has not this sensation, we may suppose the existence of mucous accumulations, strictures, or adhesions, in these cavities: the method of distinguishing these will be detailed afterwards.
Passing over the rest of the introduction, we come to Dr. Kramer's division of the chronic diseases of the organ of hearing. These he divides into three classes:
1st. Diseases of the external ear, i. e. of the external
2dly. Diseases of the middle ear, i. e. of the Eustachian tube, and the cavity of the tympanum.
3dly. Diseases of the inner ear, i. e. of the labyrinth. The first class again is subdivided into
1st. Erysipelatous inflammation of the lining membrane of the external meatus.
2dly. Inflammation of the lining membrane, with a disposition to polypous growths.
3dly. Inflammation of the lining membrane and the subjacent cellular substance.
The following are the symptoms of the erysipelatous inflammation: The patient, if he attends to his feelings, observes an itching, prickling, burning, or tearing sensation in the meatus, which causes him to thrust his finger into it; to this are soon added tinnitus aurium, with oppressions and a sense of stretching and fulness in the meatus; there is even confusion and heaviness of the head, (on one side only, if but one ear is affected,) which become very troublesome, and, together with the tinnitus aurium, even prevent the unshackled activity of the mind.