As a result of scarlatina, three differ ent conditions of the aural mucous mem brane are noted: 1. Great swelling, with serous infiltrations of the connective tissue stroma. In such conditions the exudate is purulent and tends to per foration of the drum-head. 2. Necrosis of swelled mucous membrane; so that, in many cases, the ossicles are denuded of periosteum. 3. Acute carious process upon the wall of the labyrinth and the ossicles. This condition soon leads to inflammation of the membranous laby rinth. L. Katz (Deutsche med.-Zeit., July S. '90).
Deafness, tinnitus, and vertigo may be caused by either congestion or anemia of the labyrinth. The inhalation of a few drops of nitrite of amyl will tempo rarily relieve these symptoms if they be due to iselKeinia, but will increase them if they be due to congestion. This dif ferentiation of etiology will enable the physician to properly treat the disease. Lermoyez (Ann. des Mal. de l'Oreille, July, '96).
.Apoplectiform affections of the laby rinth in two men employed in submerged caissons. When the Eustachian tube is permeable the ear endures the increased atmospheric pressure in submarine cais some : when it is not permeable, the in ward pressure of the membrana produces congestion of the drum-cavity and finally of the internal ear. F. Alt (Aust. Otol. Soc., June, '96; Ann. des Mal. de l'Ore ille, Jan., '97).
Syphilis.
The stigmata of inherited syphilis are to be sought in the typical facies; with it exaggerated naso-labial lines, the high vaulted palate, wide-spaced and pegged incisor teeth, only sometimes notched, the clouded corneae or nodes upon the shin or other bones. The family-history, with miscarriages and early deaths or typical lesions in other members, may be our only evidence.
Absolute deafness cannot be merely tympanic; in such cases we can con ceive of no obstruction which could totally prevent conduction to a sensitive labyrinth, and must assume impairment of this or the centres beyond. In some instances where the response to tests is uncertain or contradictory, the presence of Hutchinson teeth, interstitial kern titis, or other evidences of congenital syphilis may serve to warn us of the probability of deeper trouble, even if the abnormality of the drum-beads may seem to account for the deafness as tympanic.
In any case where the patient seems worse for inflation, it will be well to re view the tests for suspected affection of the internal ear; and unless explanation can be found in an overdistended drum head or unintentionally vigorous use of the air-douche, even negative findings must put us on our guard. B. A. Ran
dall (Phila. Polyclinic, Feb. 8, '96).
Form of acute syphilitic affection of the ear, probably due to an effusion into the labyrinth in a previously normal ear, is characterized by sudden deafness, tin nitus, and vertigo, coming on in the late secondary or early tertiary stage of sys temic syphilis. The difference between this form of sudden deafness, tinnitus, and vertigo, and that due to non syphilitic causes is that the deafness is not so profound in the specific form. The syphilitic aural affection yields promptly to a few doses given hypo dermically of pilocarpine grain), whereas non-syphilitic labyrinth diseases are entirely unaffected by pilocarpine.
E. A. Crockett (Boston Med. and Surg.
Jour., Feb. 11, '97).
Treatment.—Whether syphilitic or not, the same treatment is indicated. Ab sorption of the infiltration by mercurials and iodides constitutes our main resort. In recent specific cases Politzer's• vigor ous use of pilocarpine has given excellent results in some cases; but the treatment cannot always be borne, is inconvenient with its sweatings, and can hardly equal for the ear or for the general condition the usual antisyphilitic medication. Long-standing cases offer little prospect of benefit, but they have been known to gain beyond all expectation; and the underlying disease may in itself demand treatment.
Nitroglycerin exerts but little influence in disease of the labyrinth in hereditary syphilis (where the iodide of potassium yields better results). It is of the great est utility in the removal of extravasation or recently - organized lymph, especially in acute processes in the labyrinth. Politzer (Wiener med. Matter, No: 4, '88).
Subcutaneous injections of pilocarpine, beginning with 2 drops of a 2-per-cent. solution and increasing to 8 drops, are of great service in all recent affections of the labyrinth. From 10 to 15 injec tions ought to produce the result aimed at; if not, the remedy is to be aban doned. Politzer (Lancet, Jan. 2, '91).