In treatment of MOiii-re's disease re liance placed upon quinine, especially in the chronic forms. and combined, usually, with ergotine in equal dose, namely: from 9 to 15 7, grains daily. In the apoplectic type of the disease quinine is superfluous, but iodide of potassium is of great use. Tsakyroglous (Monatshefte f. Ohrenh., Nov., '92).
Three cases of Maiiere's disease cured by the administration daily of three Powders containing each 4(3 grains of bromide of potassium, and three pills,— valerianate of iron. 15 V, grains; opium, 4 g.ains; extract and powder of cascara sa-grada, q. s. ad pil. xij. The cure was permanent. Romeo Mongardi (Annales des Mal. de l'Oreille, etc., Dec., '92).
In the apoplectic form, rest in bed, counter-irritation by means of blisters, and large doses of the bromides are indi cated. In some cases pilocarpine may be tried to restore the hearing. However, in most cases of this form, the treat ment is unavailing. The epileptic form offers much better chances of improve ment under the administration of bro mides in large doses, or, still better, hydrobromie acid in doses of 48 to Co minims. In a few cases sodium salic ylate is productive of good results. Large doses of quinine have not given good results in personal hands, but qui nine in small doses, combined with iron and strychnine, is an efficient tonic. Concomitant otitis calls for its own treatment. Occasionally a blister will improve the hearing and diminish the Hunan's aurium. The use of pilocarpine is seldom advisable. Pritchard (Merck's Archives, May, 1901).
The effect of quinine, salicylic acid, and other drugs upon the labyrinth is often misunderstood. They certainly cause hypermmia in physiological dose; but probably here, as elsewhere, in toxic doses produce profound ischwmia, such as is seen in the eye in quinine-blind ness. Diseased ears are apt to be espe cially susceptible to the tinnitus and other discomforts of these drugs; but it is an open question whether they are more prone to be injured by them than normal. Malarial affections may leave marked or total deafness when no qui nine has been given: and many a case has unjustly drawn blame upon the phy sician because he has given quinine when his only error, if any, has been in giving too little. Just as in the tympanic in
flammations, stasis must be overcome at times, and quinine is often our best, if not the most comfortable, means to this end. As the prejudice against it is wide spread, however, great caution must be employed in its use; even those with anmmic tinnitus, who find prompt relief from its exhibition, showing sometimes the greatest reluctance to take it.
Akin, perhaps, to these cases are the losses of hearing following mumps, diph theria, and other acute affections. They can, perhaps, be best compared to the blindness following ptomaine-poisoning from sausage and such foods. There is certainly microbic invasion of the laby rinth in some of the diphtheritic cases; but these are apt to show the more usual septic inflammatory reactions. Acoustic atrophy, like that of the optic nerve, generally calls for an alterative course to limit and repair, if possible, the ulterior lesion, followed by vigorous strychnine stimulation.
Occupation-deafness.
Finally, the matter of "occupation deafness" demands our consideration, since it offers a valuable field for pro phylaxis. "Boilermakers' deafness" is met among workmen in many trades where noise is great and continuous; but the riveter inside a boiler is naturally the most prone to suffer with the effects of such concussion upon his acoustic apparatus. Tampons have been em ployed with slight palliative effect; but the sufferer had best change his work to a safer one. Tympanic affection may be coincidently active and demand appro priate treatment, but should not blind us to the deeper condition. The rapid-fire automatic gun is likely to claim many victims in this way, just as the dentist's electric hammer paralyzed the nerve supply of many teeth before its dangers were recognized. So, too, the various methods of persistent pneumatic or phono-massage have wrought much dam age already and are likely to find count less victims yet, who are misled by a brief stimulation of the torpid nervous apparatus and press on with the measure until all acoustic reaction is exhausted.