In a case of anaemia of the labyrinth trinitrin in doses of Vioo grain three times daily permanently relieves the deafness, tinnitus, and vertigo. In cases of congestion of the labyrinth an alter ative or absorbent treatment is indi cated. Lermoyez (Annales des. Mal. de ('Oreille, July, '96).
Pilocarpine gives the best results in syphilitic diseases of the internal ear. Thomas J. Harris (Manhattan Eye and Ear Hosp. Rep.. Jan., '97).
Labyrinthine Effusion (Meniere's Dis ease).
Another notable group includes the cases of labyrinthine effusion causing vertigo and deafness, generally associated with Meniere's name. "The Meniere complex of symptoms" is now generally spoken of, and some writers have not only differentiated tympanic vertigoes, but have inclined to deny the reality of "Meniere's disease." Yet, clear-cut cases of this affection do undoubtedly occur, and the influenza epidemics caused not a few of them. The seizure is usually apoplectiform, with intense vertigo, not infrequently severe nausea and marked deafness. Some cases note the dizziness only on rising, but others are almost as distressed by it while at absolute rest in bed. Whether the acoustic or the co ordination areas of the labyrinth are the seat of the lesion, both functions are at first profoundly affected; but the mere serous effusions can probably absorb pletely, leaving no loss of hearing. As the labyrinth vertigo is usually an irrita tive lesion, disappearing equally whether resolution or destruction be the result, it is possible that all of the profound affections are exudative or luemorrhagic, but that we have no means of recogniz ing the destruction left in the semicir cular canals, if the limited lesion is here. Some eases of typical labyrinthine apo plexy recover almost completely, but with a permanent gap at some part of the auditory scale.
In gouty cases a train of symptoms suddenly arises, resulting from serous effusion into the labyrinth, and giving most of the characteristics of disease,—tinnitus and deafness, especially for tones of high pitch, being intense. The musical sense is lost. The attack disappears, but recurs with ever-short ening intervals of health, and produces progressive impairment of hearing. A
point of differential diagnosis between this condition and a simple catarrhal process is that, in the latter, there exists an inequality in hearing between the two ears. In labyrinth effusion, the conduct ing apparatus being unaffected, the note will he heard as one clear sound. Alex. Ogston (Med. Press and Circular, June 11, '90).
In two cases the patients presented all the phases of INIC'nie're's disease, while the parents and other members of the family suffered either from similar symptoms or from nervous manifestations. Simon (Johns Hopkins Hosp. Bull., Sept., *93).
Meniere's disease is relatively frequent in eases of ozrena, while middle-ear ca tarrh with nasal disease has occurred in many eases. Among constitutional dyscrasias syphilis is a frequent exciting cause of labyrinthine Incmo•rhage, while many cases may be traced to Bright's disease, atheromatous arteries, exertion, trauma, mumps, etc. Thomas Barr (Brit. Med. Jour., Dec. 28, '95).
The deafness resulting from an intense extravasation within the labyrinth, such as occurs in Miini&re's disease, never dis appears and is usually bilateral. T. A. Kenefic (Med. Record, July 25, '96).
The main cause of chronic car-vertigo disease) is impaction of the stapes in the oval window, and removal of this retractive force and liberation of the stapes will cure this. Removal of the ineus to break' the retractive force of the tensor tympani and malleus exerted through the incur upon the stapes. In chronic purulent cases excision of the remnants of the diseased membrana tym pani and the malleus and the ineus, with their svnechial bands, to liberate the stapes. This, with treatment of the puru lent drum-cavity, is followed by cessation of the vertiginous attacks, and em-e of the chronic puruleney. H. Burnett (Phila. Med. Jour.. Sept. 22, 1900).
Treatment. — Total rest, derivatives, and perhaps blood-letting should be first tried, followed by absorbent alteratives. Charcot's use of heroic doses of quinine should be a last resort, as a means to complete the destruction of tissues in capable of resolution.